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Comment by tehjoker | Hacker News Reader

Price discovery doesn't help you. If you get knocked out, heart attack, your arm cut off, whatever (i.e. a lot of the expensive stuff) you just go to the nearest hospital, no consumer market finagling is even possible other than trying to live near a good hospital.

Other times with chronic conditions where theoretically price discovery could help, the problem is that you need care badly so all the chronic care providers jack up the prices super high beyond what is needed. Treating this as a market in any way is a crazy system. If the government pays market rate, they jack it up even more. So the solution has to be that the government has to set the prices either directly or by negotiating with an entire population at its back and no competitors (i.e. monopsony in the public interest).

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The biggest fuck you is that Medicare can't negotiate.. it's actually written into the law.

That's not true. Medicare can and does negotiate the cost of procedures and doctor's services. What the law says is that Medicare can't negotiate prescription drug prices. That's because Medicare doesn't directly pay for drugs, except what's used incidentally in the course of covered hospital stays.

Medicare didn't provide coverage for prescription drugs until the adoption of Part D. That is structured differently than other parts of Medicare. Instead of the government serving as the insurer directly, the government subsidizes premiums for a private Part D insurer. The private insurer can and does negotiate drug prices.

The fact that Medicare can't negotiate prescript drug prices is often invoked as a talking point, but Medicare prescription drug spending accounts for a relatively small proportion of. overall Medicare spending: https://www.heritage.org/medicare/commentary/good-and-bad-id... ("Consumer choice and competition have made Part D the rarest of government programs: one in which spending hasn’t spiraled out of control. In fact, government actuaries report that federal general revenue spending on the program was $67.8 billion in 2018—that’s less than what it spent in 2015 ($68.4 billion).").

That's 1/10th of the military budget for drugs that can be often be manufactured for pennies (drugs with biological elements requiring glass column filtration and such are a different story but are far more rarely used).

A point in case is the Hep C vaccine: https://www.medicalnewstoday.com/articles/323767#drug-types-...

The manufacturing costs are irrelevant for new drugs. If the drug companies couldn’t sell them at a profit, they would never develop them in the first place.

There is an issue with some old out of patent drugs that costs a lot despite being very cheap to manufacture, but that typically has to do with FDA certification deciding who can be allowed to produce what, which is also expensive to obtain.

And the Moderna vaccine was designed in two days: https://www.businessinsider.com/moderna-designed-coronavirus.... Is that all there is to it?

There was 10+ years of research prior, but much of that research was academic. Phased studies must be conducted regardless of whether manufacture is public or private. There does not appear to be any need for private profit, we are sufficiently motivated to research this stuff out of a desire for self-preservation.

I'll admit that profit seeking would work better* in a society that doesn't have a strong state or other coordinating body, but given that one exists to counterpose our existing system is not reasonable.

EDIT: * In the sense that products might be produced at all. Without a strong regulatory body, the market would be flooded with snake oil medicine and the average consumer would not be able to make heads or tails of things. This is because it's much cheaper to make a fake medicine than a real one, which is what profit optimizes for: the cheapest solution with the highest payoff for the seller regardless of costs not borne by the seller (such as death and destruction writ large).

I believe that’s specific to drug prices. Services are interesting in that they just dictate it.

Blackmail. I believe that is the word. Then end of life care comes along and you better own your house, because that is going to be gone after all the bills come in for end of life care.

The sad thing is, as expensive as healthcare is they probably have to jack up those rates because they are getting screwed everywhere else. In the end, though, the consumer is always the one who ends up getting the ultimate screw... exactly why healthcare shouldn't be seen as a service to consume.

While so much of the cost is the care that the organizations provide and what they choose to charge there is some truth to what you are saying.

Had to get an MRI and the lab corporation that performed the MRIs said that it would be ~$850 if billed through insurance. This included the total cost minus what was covered by insurance so the initial cost of the procedure was in the ~$1200 range. BUT, then they said if we just paid them directly and they didn't have to bill through insurance it would only be $650. So our insurance didn't even cover the absolutely ridiculous amount of overhead that was added just to deal with our insurance provider.

You don't really need anyone else screwing over the hospital to have for-profit hospitals be incentivized to screw the patient by jacking up prices on demand inelastic goods. Not to even mention that many times the patient chooses these procedures while not thinking clearly, when under duress, etc.

These organizations charge exorbitant amounts of money for the care they provide. This is care which very few people are able to refuse. And if you do refuse care you are likely to die. What hospitals do would be considered extortion if a private citizen did it.

I have no sympathy for them whatsoever.

Sympathy has nothing to do with it.

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