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What people don't like to admit is that free markets don't work for healthcare. What is the price you're willing to pay for curing that tumor in your gut? Everything you have. There is no supply vs. demand. Only supply vs infinity.

What would happen to the food market were it not for the generally high supply of food? It wouldn't be pretty.

Because of that, some sort of non-market intervention is simply unavoidable. As are the inefficiencies that go along with price controls and other similar endeavors. Ugly stuff, this healthcare business.

This is a weird summary of how "free markets" and "supply and demand" work. Yes, you will pay everything you have for a cure. But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

But the guy who will offer you a cure for "everything you have minus one dollar" is going to get your business.

Not necessarily. Suppose you have a deadly condition. Your information is extremely limited as non-professional. Would ... you can pay all your money now for the cure your doctor offers or you can wander over to an unknown provider for the best price? The quality of unknown providers is ... unknown and your doctor is known. And he knows he's got by the genitalia and will charge accordingly since with even a thousand unknown providers, your real choices are very limited.

Just as much. Presently, no American hospital publishes its price list. I believe there's no regulation about this. Why hasn't "the market" impelled these providers to publish their prices.

Presently, no American hospital publishes its price list.

Almost every American hospital publishes its price list to its primary customers: the insurance companies. The problem as I see it is that the insurance companies are the only entities that can get fair prices for health care, and they want to keep it that way. A potential solution would be to ban insurance discounts; a health-care provider could charge any price it wants, but it would be required to charge all customers the same price. Insurance companies would still negotiate for lower prices, so it would benefit all of us.

My experience has been that if you don't have insurance, the hospital will cut a big chunk out of your bill immediately. Their "negotiated rates" are all just made up things they put on the insurance bill because insurers can pay a lot of money. The insurer calls and says "Hello, I would like a discount". And the guy says "Ah, yes, our standard rate is cash rate + $1000, but for you, I'll take off $500".

For instance, a podiatrist I know charges $350 to the insurance company (which shows this as the discounted, negotiated rate) but $150 cash to remove an ingrown toenail.

I'm sure there are exceptions.

Just had a pair of major surgeries in my immediate family. When we offered to pay cash, they immediately knocked 50-66% off all the costs. That included anaesthesiologist, room rental, and doctor's time.

This "retail rate" mentioned in the article is crap.

I see this cash discounting frequently, and it makes sense, as it's easier (faster, more certain) for the doctor to take the cash than to deal with billing the insurance company.

A bigger problem I have is that it's hard to get this information ahead of time. Hospitals don't want to tell you, if you come in for this operation and are willing to pay cash, total cost will be $x (and it should be total cost, including rooms, drugs, anesthesiologist, surgeon, nurses, etc.). If you could get that quote, you could comparison-shop hospitals ahead of time.

My doctor and I had this discussion recently. He said that he is legally not allowed to advertise or share prices. The laws won't allow it as to prevent price fixing.

This was in Texas, so maybe someone that understands the laws can chime in and comment on that.

I work in healthcare and while I might be incorrect, this is my understanding of the situation.

Medicare is the largest payer of insurance claims by far. Medicare also has a lot of rules. One of these rules is that, in order to prevent providers from shortchanging Medicare, they have to charge everyone the same price (otherwise medicare would be overpaying....). Medicare will then pay 80% of the indicated amount and the rest is covered by medigap insurance, Medicaid, or by the patient.

As you might imagine, the lack of ability to price discriminate, even to patients, hugely distorts the market. However, private insurers have gotten around this (how I don't totally understand), by using what is called the contractually "allowed amount". This is an agreement that the provider will write off the variance between the allowed amount and the billed amount. This results in de facto price discrimination for large insurers while getting around the medicare law. Patient's don't have this kind of gig.

Of course, there are tons of other corruptions and inefficiencies in the system. I could tell you a story about a friend who once worked for NY Medicaid who was actively prevented from working to prevent the state from going bankrupt by paying claims.

I don't have the answers, but there is serious distortion of the market ATM.

If you dig enough in the medicare automated billing system documentation, you can find prices for particular codes. At least what medicare is willing to pay.

I hope I never have to use this information, but it's out there.

here's the medicare fee schedules. You need to map codes to costs and locations, but it's doable.

http://www.cms.gov/FeeScheduleGenInfo/

I will try to speak for the parent. I think that he meant that everything being equal most people would rather save that dollar.

What are we discussing here? Do you not know the difference between elastic and inelastic markets? Health Care cannot ever be a free market because it is utterly inelastic.

By that argument, food, water cannot be a free market either. I am not saying that health care works best in a free market or not, but whether it is elastic/inelastic is not the only factor. Also, depending on which health care we are talking about, it is certainly elastic: sure, if you just got shot and are mortally wounded, you are pretty much ready to pay anything you can to get treated, but maybe that private room or new cancer treatment twice as expensive without proved benefits is not that necessary.

No he wont. The next guy that comes along and offers a cure for "everything you have minus TWO dollars" gets the business, and so on, until an equilibrium is reached where it is not worth being in the business by offering cheaper prices.

That's not exactly encouraging.

You're not encouraged that there's price competition in health care, or you don't believe that there's price competition in health care?

Deleted comment

Sorry - I was joking. Perhaps I should have added a smiley. I get what you're saying. I also think that:

1. the medical industries/professions work very hard at discouraging price competition.

2. price competition is not sufficient to create a healthcare marketplace that works well for society. I'd like to see people without means have at least some access to medical technology/services, even at the cost of inefficiency. But that's just me.

Like I said - it's a beast.

that is true for certain procedures, and not true for others.

you don't have time to shop around for services while unconscious in the back of an ambulance.

Few will admit that we don't have anything close to a free market in healthcare today (or for the past several decades). A truly free market is one unfettered by the FDA, medicare, medicaid, doctor regulations, hospital regulations, HMO regulations, insurance regulations, etc. All of these controls were ostensibly put in place to protect patients, but in actuality they serve to slow innovation and true access to medicine to a crawl.

It is true that some people will choose badly when left to their own devices, but that's better than forcing the same dumb rule on everyone. Each of us is an end in ourselves. So long as we do not violate the negative rights of others, we are responsible only for our own lives, not the lives of our brothers.

How wrong you are.

No man is an island. Neither you, nor anything you create is created in isolation.

Dependencies are ever-present and failing to understand this leads to failed ideas such as "true free market" not unlike the idea of "true communism".

In reality the very fact that you are alive to write your words is a testament of other peoples effort including your parents to guard you against the many many dangers in this world.

Ultimately you don't own the right to anything, not even yourself.

It's an agreed upon right not a natural law.

I agree that there are some times too many regulations. But claiming what you do here is simply wrong in a very unfortunate Ayn Rand way.

Then it's wrong in a very unfortunate Founding Fathers way also. Because the Declaration of Independence states that we DO have inalienable rights and they ARE natural laws (i.e., endowed by our creator, which is a religious way of saying natural law).

The Declaration of Independence says it, so it must be true? The DoI is, among other things, a social contract that most Americans have agreed to, which is exactly what ThomPete said.

My point is that saying the belief is Ayn-Randian is disingenuous, because a lot of founding fathers believed that also. But I guess it's easier to diss on Ayn Rand than it is on Thomas Jefferson.

It's easier to diss on Ayn Rand because her claims are so much bigger. I am not American btw, so I don't have any specific problem dissing Jefferson, I just don't see why I should. I am not against property rights I am against the idea that property rights are natural rights.

I can forgive Jefferson for living in different times, but Ayn Rand should have known better.

The Declaration of Independence is not a natural law it is in any sense of the word a political law.

The Founding Fathers declaration doesn't apply to the 5.8 billion people who lives outside the US.

And even if it did it would not by any metrics be a natural law. Property rights is a human construct nothing else.

For someone who puts so much faith in free markets you don't appear to understand how they work. In your studies, look up "market elasticity" for a clue.

The phrase "market elasticity" is meaningless.

Elasticity in economics describes the relationship between two variables (normally price and demand which is price elasticity [of demand] but by no means exclusively).

But unless you define your variables (or state what sort of elasticity) it's not a useful term and certainly not something I'd be bandying about while suggesting that someone else didn't have a clue.

>The phrase "market elasticity" is meaningless.

Nonsensical. What kind of market theory are you following that doesn't factor in market elasticity? Rush Limbaugh eco 101?

Market theory as I was taught at university during my degree. And you?

As I said the term elasticity isn't meaningless, but without defining the variables you are defining as elastic (or inelastic) it doesn't make sense, at least not without assumptions which obviously may or may be wrong.

Personally by default I'd assume that you were referring to price elasticity of demand - that is the relationship between changes in price and the resulting change in demand, however there are many other types of elasticity (see http://en.wikipedia.org/wiki/Elasticity_(economics)).

So if you want to explain exactly which variables "market elasticity" refers to then that would be great, but as "market" is a very loose term, on it's own it's not very useful.

If you have a degree in economics then you should know very well that health care can not function properly in a laissez faire market. Customers cannot simply "opt out" of health care.

I've not said anything about what I believe in this area (certainly not in this section of the thread), I've merely questioned your use of the term "market elasticity" and what exactly you mean by it.

You're just trying to get me into a semantics battle so you can find some slight difference in my understanding of a word and the text book definition. What is the point of such conversations? Do you dispute that health care cannot function properly in a laissez faire system for the reasons I have mentioned so far?

The point of such discussion is about respect.

You pulled someone up for not knowing what they were talking about ("For someone who puts so much faith in free markets you don't appear to understand how they work. In your studies, look up "market elasticity" for a clue."), when it seems the same accusation could be levelled at you.

But, I never really meant it to become a big deal so I apologise for being picky and I'll move on to answering your question.

Broadly I agree with you but I think it's slightly more complex than that a straight forward "it doesn't work" and for me the issue is how you factor in the failures which in healthcare tend to result in injury or death. For instance, would a law covering corporate homicide (that is an organisation causing the death of someone in the course of their work due to incompetence or carelessness) count as market regulation? Or even manslaughter if a doctor acting alone did the same? Would that be regulation?

Because of this I think any civilized society wouldn't accept the possibility of severe injury or death without significant consequence, so even if it might work in theory (more below), we'll never know in practice as it would never be allowed to come about.

More generally though my view is that markets of any sort only work well when you've got a few factors at play:

(1) the deals and decisions are being made directly by those they impact - that is the patients so the deal genuinely reflects the will and interest of the patients (as opposed to them being one step removed as with insurance companies where their interests muddy things)

(2) the system has to be such that there is a financial consequence to the patient of the decision they make (that is they see the benefit of getting a deal which is good value as well as good medicine otherwise why would they look for value)

(3) there has to be as close to perfect information as possible to allow these decisions to be made on a true and fair basis - and when you look at the PR machines we see today exist, you've got to think that's not going to happen without regulation.

My issue is I don't see how you'd consistently get those factors without regulation. I couldn't say it's impossible but it certainly seems highly improbable, certainly in the culture we have now (point 3 being the one I can't ever see coming about without enforcement).

As an aside - I live in the UK where we have nationalised healthcare and it's frankly great. The market reforms over here terrify me because they're ideologically driven by people who seem to want to drive us towards an American system so in theory while I'm not intrinsically against the market playing a greater role in health provision, in practice I'll tend to fight it on the grounds that it looks like they're going to the whole thing up a treat.

How is that relevant here?

Health care is, by definition, an inelastic market.

The point being? Sorry if I'm being dense, but no market is truly elastic.

Not true. I don't have to buy a smart phone, for example. I can live a wonderfully productive life with a normal cell phone. This means the price we see for a smart phone tracks very close to its value. You cannot do without health care. If you get sick you will pay any and every price to get well. If you die, your money is worthless anyway. A market you cannot opt out of is inelastic and normal free market forces wont be able to find the correct price as they would in a more elastic market.

You cannot do without food either, but food markets are pretty elastic because you can do without food from any particular seller. If there's a variety of healthcare providers of reasonable quality then the usual market mechanisms can work.

Which isn't to say either (1) that they actually do work well in, say, the USA, or (2) that some less free-market-based system mightn't work better. (I'm in the UK; the situation in the US looks absolutely horrifying to me. I don't know what an ideal healthcare system looks like, but it surely can't be that.)

An individual's need for food is generally stable, predictable, and bounded (eg, 2500 calories/day). An individual's need for health care is unpredictable and unbounded, meaning that you can be financially ruined by it in a sudden and catastrophic way. Having a variety of providers doesn't address this crucial difference.

"What would happen to the food market were it not for the generally high supply of food? It wouldn't be pretty."

You turned cause and effect upside down. You think the free market for food "works" because food supply is "abundant"? Think again. The supply is high because it's market is "free" (not really but fairly) globally and (sorta) works.

If only doctors were as easy to grow as carrots...

They sure are not more expensive to grow than good engeers or teachers?

And of course, they will grow better if they eat their carrots ;-)

> free markets don't work for healthcare

Healthcare can be broken up into a lot of smaller markets, and for a lot of those the free market works just fine. The market for coffee in the cafeteria of the hospital works fine as a free market. Do you know what percentage of healthcare cost pertain to the cost of the actual treatment itself? (hint: it's a very small part)

Could you please cite somewhere in the world where the free market is working for health care? Every other first world country either has socialized medicine or a tightly regulated health industry.

Singapore - arguably the most efficient healthcare system in the world. Tim Harford talks about it in his excellent book "The Undercover Economist" (worth commenting that he's not rampantly free market - he spends time putting the boot into the US system too as well as praising the UK's NHS).

Basically everyone has to maintain a fund (the government pay into it for the poorest) for healthcare. This is what they spend when they have healthcare needs.

Because the people are making the purchasing decisions themselves (as opposed to the insurance company doing it) they have a far stronger incentive to demand value and to be informed, and you get genuine competition between providers (as if you don't like them this time you'll go elsewhere next time with no insurance company mandating who you can see).

The government then picks up the few areas that aren't well catered for by this system.

I think it costs about 40% of what the US system costs (possibly even less) and Singapore has a typical life expectancy of 80.

"Singapore"

... has a price- and service-controlled market, set not by the healthcare industry but by the Singaporean government (you know, the guys that cane graffiti artists and banned gum-chewing?) They also provide government subsidies to citizens as well as permanent residents (though not as much) for their compulsory Medisave program. So, their invisible hand is very visible and it's called "their government regulates or pays for alot of their care".

Basically everyone has to maintain a fund...

And with that, you're no longer in a free market.

If you want a definition that tight then I'm not sure that you'll find a first world country with a free market for healthcare, working or not.

Good point. I over-simplified. There are many causes to the current state of the healthcare market, only one of which is the problem I described.

The free market does work in healthcare, you just need a government option as a baseline. If someone wants better care then the socialized healthcare, they are free to pay. That's the system in England and Australia.

This is basically a recap of the Japan segment of the Frontline special "Sick Around The World", which you can watch online at: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/.

The Japanese system is not without its problems. More importantly, the "price fixing" approach to health insurance simply isn't going to happen in the US. What parts of it do you think we really can adopt? Because nobody is going to fix US healthcare by fiat.

"More importantly, the 'price fixing' approach to health insurance simply isn't going to happen in the US."

Why wouldn't it? Would there be riots in the streets? Roving gangs of healthcare-affiliated hooligans throwing rocks, burning patient effigies? Doctors lining up to leave the country en masse for a freer medical marketplace or just throwing dirt in the eye of medicine to go be a quant trader at a hedge fund?

The more important question is: Why hasn't that happened worldwide, in places where there truly _is_ universal/free/government healthcare?

"What parts of it do you think we really can adopt? Because nobody is going to fix US healthcare by fiat."

And, nobody but the rich and upper-middle class will be able to afford healthcare by Market. We can already see that today, with over 50 million uninsured Americans, up from 37 million just two years ago. How many will it be next year?

No, there won't be riots in the streets, because it would take amendments to the Constitution to institute price-fixed health care. Clinton's wildest single-payer fantasy (which, coincidentally, is one of my wild fantasies) would be easier to accomplish, and it, too, is D.O.A.

My objection to your point is twofold:

(1) It is total wishful thinking.

(2) It's wishful thinking in the face of pragmatic solutions that could resolve the problems we have now without utterly restructuring the market for health care.†

I'd also appreciate it if you wouldn't attempt to frame any critique of your comments in terms of "you're either with me or against health care reform". As you can see from a casual glance at this vast, Reddit-like thread, few opponents of health care reform would dare poke their head up on HN these days. I'm not an opponent of reform.

† Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance, an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today), and broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics.

Price-fixed health care may be a bad idea, but I don’t think it would be unconstitutional. The Supreme Court retreated from that whole line of interpretation during the New Deal; in the early 1970s, wage and price controls were instituted by that notorious socialist, President Richard M. Nixon.

"Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance"

Guaranteed-issue meaning "you have to get it, but we [the insurer] can charge whatever the hell we want. So, you, small biz of 10 employees with one person who had cancer, you premium is now more money than the GDP of Haiti, per month. Thanks and come again!"

That kind of practice can be fixed by either 1) price-fixing or 2) subsidies forever, the latter of which is really, REALLY expensive.

"an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today)"

The one that the Obama administration just gave $240 million to 7 states (Kansas $31.5 million, Maryland $6.2 million, Massachusetts $35.6 million, New York $27.4 million, Oklahoma $54.6 million, Oregon $48.1 million and Wisconsin $37.8 million) to implement as part of the healthcare overhaul passed last year? I think it'll work, too. Funny how that needs federal dollars, though. Shouldn't the free market sort this stuff out without the magic hand of socialism?

"Broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics."

That I'll agree with, big time along with EMR mandates. That with HIPAA are a big step toward alleviating alot of the administrative burdens in healthcare management, especially tracking and billing.

When one person in a typical mid-large group insurance plan (of the sort available to contractor "guilds" today) gets cancer, premiums for the group do not shoot up. It's hard for me to take you seriously. You sound like a DailyKos diarist.

I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat. So, first, you attempt to paint me as against all reform and in favor of people dying instead of companies going into debt. Now, you've tried to reframe the discussion so that you're either in favor of market-based approaches or a "socialist".

And, after you've done your level best to suck all the oxygen out of the conversation, it turns out... you agree with me.

Please stop writing like this on HN.

"When one person in a typical mid-large group insurance plan (of the sort available to contractor "guilds" today) gets cancer, premiums for the group do not shoot up."

I didn't say they did. I said 10-person startup. And, regardless of the existence of an "exchange" or not, policies of that size will still be meted out case-by-case, and those little start-ups will get squeezed, especially if they have someone on board with a pre-existing condition.

There's no getting around that problem unless each state acts as a group insurance pool. You will ALWAYS run into the small business, part-timer, or self-employed worker problem. Full stop. No arguments.

"it turns out... you agree with me."

Let's get this out of the way from square one: I don't agree. At all. In principle or in general. I may agree in some finer details, but my ultimate pie-in-the-sky wish for America is for us to implement a mandatory system in which every man, woman, and child, regardless of age or infirmity can get covered for a nominal price, unless they are a religious or conscientious objector and chooses to opt-out, but must themselves still pay, like we do with defense.

"I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat."

And, I disagreed that the free market cannot correct what is here _in practice_. Not some theoretical America where we didn't have a glacially large government or a sedentary populace with 50 Million uninsured that didn't eat Cheetos and Mountain Dew for dinner. I'm talking about the reality of the situation and how it will take more than EMR and telemedicine changes to close that 50 Million (and counting) gap, though I do agree that technology can play a non-trivial role in cutting administrative costs.

See, I have wiggle room and patience for negotiation.

"Please stop writing like this on HN."

You, I can see, don't.

...it would take amendments to the Constitution to institute price-fixed health care.

Government-dictated pricing wouldn't necessarily violate the Constitution, it's been done several times throughout American history.

I think the goal was more to state that our government is heavily influenced by rich special interest groups, who won't let it happen here, even if it costs them billions of dollars every year to fight it off.

Funny mental picture though :D In my head they're wearing those stereotypical nurse hats and brought their own stretchers to carry off the wounded / exhausted / weaponry.

Isn't price fixing is done for U.S. Medicare payments to doctors, hence the constant wailing over the "doc fix" issue?

I can imagine a scenario where the age for Medicare was lowered slowly over time to cover more and more people. (Unlikely, but not beyond the realm of possibility).

I think that someone else said it here (somewhere in these threads), but I believe Medicare mandates that everyone is charged the same price for procedure X, but doesn't mandate what that price is. The point being that if everyone gets the same price, than Medicare always pays the cheapest rate (since there is only one rate).

What Tommy Douglas did was revolutionary, but Canada's healthcare system is no longer something to be proud of. We have some of the highest wait times for Cancer patients in the industrialized world, hurried appointments, cuts in coverage. I don't blame the government, I blame us Canadians. If you've seen the Micheal Moore movie, SICKO, you've seen the average Canadian's view on our system, which is, that it is truly great.

The government is getting a pat on the back for removing essential services because the masses aren't taking notice; we've fanboy-ed our system while ignoring its degradation of the fundamentals. Our current system is not a positive guideline to success.

A Macleans article about the state of our system: http://www2.macleans.ca/2011/01/25/our-health-care-delusion/

Japan's hospitals are going into debt because they can't charge what things cost. http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/c...

So, the solution to that in the US is for the patients to either die or go bankrupt rather than hospitals or insurers going into debt.

Everything has a price, but that seems a little lopsided.

This is an utterly nonresponsive comment. If the economics of providing healthcare don't work out, they don't work out. It's not as if "go into debt" means "fat cats make less money". No, it means that the skilled labor and capital that drives the insolvent health care system will simply migrate somewhere they can deliver it profitably. Say goodbye to hospitals for rural and poor areas.

"Say goodbye to hospitals for rural and poor areas."

That was happening anyway, if it weren't for Medicaid, that is. There was a definite brain drain of doctors (especially specialists) who choose to go to affluent suburbs and urban areas simply because they get more (and better quality, AKA rich) patients. You think if we _further_ privatized the market, those in rural areas would be _better_ served? Isn't that the opposite of what the free market would actually do? In fact, take a look at this study[1] about physicians in rural America. It's eye opening how they advocate federal and state intervention (read Medicaid and Medicare) as one of the solutions (along with opening training up to more potential candidates, which even I as a liberal elitist supports).

[1]http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071163/

Few doctors want to live in a rural area for lifestyle reasons more than salary. A GP or surgeon can make more money in a rural area.

How? Do they charge higher rates than elsewhere - effectively using supply and demand and saying: "You don't have anywhere else to go, so pay my rates."

Most doctors these days are salaried employees at a large health care organization. They get higher salaries in the sticks because nobody wants to work there.

Ah. Thanks for that info.

Source for this assertion? It seems more likely (to me) that they'd make less due to their smaller and less affluent clientele.

Well neither is sustainable, so neither is a solution.

I generally trust a self-correcting free market over a government bureaucracy to solve such problems, but in this case it seems the fundamental problem is that there just isn't enough margin for for-profit insurance companies to prosper without turning the screws on either doctors & staff, patients, and/or taxpayers.

Since we in the United States end up expending at least double per capita what Japan does then we should be in the clear then, right?

The Medicare system in Australia works in a sort of similar way to how you describe Japan. The government publishes a list of fees for every possible procedure and treatment. The medical service provider can "bulk bill" where they collect the money directly from the government, and the patient never hands over any money. Alternatively, the provider can charge whatever they want (because they're a noted doctor, or their office is in an expensive location, etc.), and the patient can then claim the set amount back from Medicare.

Bulk billing is so much more convenient for everyone that you'll see signs advertising it on the outside of doctors surgeries, thus the cost of care is kept down. On the other hand, the doctors are free to charge what they want. Sounds like a fair way to do it.

Thank you, thank you, thank you. Someone needed to say it!

And the funny thing is, Singapore and Japan both are rather well-off nations, not much different wage and price wise than the US. Biggest difference is medical cost...

Yeah,

In fact, forcing US hospitals and doctors to publish a price of any kind would be a simple improvement.

It is amazing with all the other twiddling that this approach never appears - at least not much.

Some may argue (though I don't) that it is tantamount to price fixing, because doctors aren't free to have a "sliding scale" of care, even though about 95% of what they do are routine. Hell, even my plumber and mechanic have a book that they're more than happy to show me for what a service costs. My broken arm, though? I _deserve to shit bricks in fear of the bill if I'm a part time cashier with no insurance. Let that be a harsh lesson to me to become a rich computer programmer.

I think the issue is just too complicated to draw conclusions from broad inter-countries comparisons. I find the Japanese system terrible - I have been living there for 7 years and I have yet encountered a foreigner coming from a rich country who thinks the system is good.

The problem with comparing global stats like cancer survival rates is their weak correlation with the health care system. For example, the reason why colon/rectal cancer survival rate is high is because Japan is basically the only rich country where those cancers are the most common one (in other rich countries, prostate, breast, lungs usuallly come first for the concerned sex). There is also the issue of "free-ride", where most western countries benefit from research being done in the US and a couple other countries - which is not so easy to quantify either.

Designing good indicators is incredibly hard, and for that reason alone I think it will always be a political question first, and an economical one second (i.e. economics can help making a decision, but it won't give you the decision).

That's an interesting way to do things, didn't know Japan did that. Thanks for the info! How much do things like emergency services cost? Do they fall under ancillary or not? Anything that's nigh-essential that does? Know if the hospitals are supported by the government, and how much taxes it takes?

For most insurance, patients pay 30% copay maximum for any procedure (emergency or standard), but the minimum monthly payment (yes, it's not due all at once, which I think should also be legislated here in the States) is capped according to income.

Hospitals are private, and both they and doctors negotiate every two years to set prices for everything from MRIs to stitches. The insurance industry is also private, but they have a public-run insurer for Japanese poor. AFAIK, taxes are taken just for the public-run insurance, to which only a small percentage of Japanese apply, but for private insurance (which the rest are mandated to have), it's paid through premiums per month, which is on average about $250/mo per family (and employers pay for almost all of that).

> FYI, there are more private hospitals in Japan than the US

Incidentally, as near as I can tell, a hospital in Japan is equivalent to a clinic or doctor's office in the US. They also seem to be open weird hours. (example http://www.youtube.com/watch?v=Mi31MJrRjhE)