1. It’s very hard to shop around to find better prices or better service.
2. People often make choices like “Do you want this expensive life saving procedure or not?”
3. The average person isn’t informed enough to understand what their medical treatment needs are. Patients ask doctors what their recommendation is. Doctors often have an incentive to sell the most healthcare they reasonably can.
4. My ability to pay for healthcare is directly tied to my employer. There simply are less jobs that provide good healthcare than people that would like them. My ability to change positions in society is limited by my desire to continue to have access to affordable healthcare. This is practically a freedom limiting mechanism.
5. I’m limited in my choice of which healthcare to purchase based on my Insurance policy. My choice in insurance policy is similar to a suburbanite’s choice in an ISP. I have very few choices.
6. Prices are often unknown at time of service.
No amount of research can make up for hospitals that haven't decided how much your surgery will cost until after the fact.
I recently paid a hospital invoice, and received a receipt covered in "PENDING FINAL BILL". I can't tell if the hospital will refund me some excess, or charge an extra $1000.
To extend the metaphor elsewhere in this thread, it's like going into a garage and being told that an oil change will cost between $40 and $400. It depends. We'll let you know.
https://www.healthcaredive.com/news/hospitals-pledge-to-figh...
However, it looks like that practice won't be allowed for much longer:
https://www.cnn.com/2021/01/04/politics/hospital-price-trans...
1. Almost impossible to shop around 2. Instead this is a Dr's or a public system policy choice. 3. Dr's incentive is to minimize costs 4. Your ability to aquire healthcare is based on limited availability and your condition. If you are critical you will get immediate care, if you need a MRI - perhaps 6 months, if you need a specialist i.e. liver doc, sleep study, orthopedic surgeon etc, 1+ year 5. You have very little choice. Finding a family doc is very constrained
OBVIOUSLY, this depends on the province as health care is a provincial domain.
The average person isn't informed about anything other than however they make money from 9-5
Consumer ignorance is not an excuse for a crappy market.
It is unreasonable to expect every consumer to be an expert in every commerce transaction that takes place in their daily lives.
Is the price of specialization and sophistication the movement of decision power away from the source of decision quality information? I find it paradoxical to use regulation as a response to the fact that "it is unreasonable to expect every consumer to be an expert" in that it is likewise unreasonable to expect regulators to be expert in the context and values of each individual consumer.
When I want finical advice I hire an expert that gets paid the same no matter where I invest my money, because his incentive is to give me the best advice so I stick with him. If I get finical advice from someone that gets commission based on selling specific investments then the advice is more likely to be less than the best.
You hit the nail on the head. Compared to buying a car, computer or apartment I'm not choosing to have a particular disease or accident. It just happens to us (yes, we can prevent some). Once you have a medical condition you are forced to "shop" for a solution in a "free market" so you can escape that situation. This is when people become vulnerable and the US healthcare model takes full advantage of their position.
6. Pricing is almost impossible to know ahead of time, even if you ask.
Trust me, I have asked how much something will cost ahead of time and no one can tell you.
One time I had to go into a specialist for my leg. I had hurt my MCL, but the doctor wasn't sure if it was torn or pulled. So he sent me to a specialist to give advice on whether surgery was needed. Before I made the appointment I asked the receptionist how much it was going to cost for this appointment. She couldnt tell me. I asked her to figure it out and call me back. She never did. I called back before my appointment and talked to the clinic manager. She again refused to quote me a price.
In the end I went to the appointment. The doctor listened to me, then grabbed my leg and twisted it a few different directions and asked me to describe the pain as he did so. Then he told me it was a simple pull. I didn't need surgery. I just needed to rest. No prescriptions, no medications rendered, no operations performed, no diagnostic tests given. A simple 15 minute doctor visit.
3 months later I get the bill. It was $800. I had to pay it all out of pocket because this specialist was out of network. I had tried to get a price ahead of time and couldn't. The doctor didn't do anything for me except tell me to rest. The visit cost him 15 mins of his time. Nothing more. At this rate, he is billing $3,200 per hour. Possibly more because the 15 minute time estimate is me being generous. It was very possibly closer to 10 minute visit.
Another one that I won't go into detail with because it would take too long was for a pinched nerve in my back. I went to urgent care because the pain was so bad I couldn't stand. Again, a simple question+answer with the doctor revealed the pinched disc in my back. No xrays or diagnostic tests were given. She prescribed me a pain killer and a steroid to reduce inflamation which would allow the disc to naturally slip back into place. Because I was traveling and so was again out of network when this happened, I asked the receptionist as I was checking in how much a simple visit runs. She of course can't quote me anything. I pressed her and said, "what is the base price. I know it is more if they have to run tests and do things, but what is the cost of the visit". She refused to tell me. As I was now wheelchair bound because I couldn't stand, I had no choice but to gamble and get the help and learn the price 4 months later. The visit cost me $1,900. I had to pay 100% out of pocket. Despite having insurance that I already pay $500 a month for.
Furthermore I had $120 in out of pocket expenses on the medications.
Not only can you not figure out a price ahead of time, but it is equally crazy that I pay this much out of pocket when I have insurance that I pay $500 a month for ($6,000 per year). And no don't tell me to "get better insurance". That means finding a different employer and guess what... it's not like you can see what insurance the other employers have until after you start working there. There is no way to really shop insurance, you are stuck with what your employers offers, usually with 2-3 options from the plans they have selected.
"If the image of medicine I have conveyed is one wherein medicine lurches along, riven by internal professional power struggles, impelled this way and that by arbitrary economic and sociopolitical forces, and sustained by bodies of myth and rhetoric that are elaborated in response to major threats to its survival, then that is the image supported by this study."
- Evelleen Richards, "Vitamin C and Cancer: Medicine or Politics?"
> The patients who went to one of these drive-through testing sites had no chance of knowing what charges they would face beforehand.
This is just stupid. There are similar stories about the cost of going to the ER. If all health care providers were required to be transparent about pricing up front, then there might be some possibility for people to shop around.
The fundamental premise, though — that the market is not ideal for healthcare —- remains. For shoes and smartphones, the market is fine. For MRIs and insulin, it is not.
If you hadn't opened with that I think we could have gotten another two or three people extending the chain of indirectly stating as much.