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Comment by joe_the_user | Hacker News Reader

No, just no

Health care is a situation where competition cannot be a spur to reasonable costs because individual consumers are simply not in the position to make the kind of "free market" choices that economists (or more often free market ideologues) expect they'll make.

Moreover, the malignant and abusive US health care system is in fact a product of layer upon layer of failed "efforts to create competition" intended to reduce cost "through competition" to the point that by now all the abusers really know the dance and will be profiting next year from any further or replacement layer you add this year. (and "no regulation then!" as the US 1900 results in doctors being just heroin dealers - like my great grand father interestingly enough).

Most other industrialized nations have a state run medical system that's far superior and cheaper than the US system. They didn't solve their problem with "competition".

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There is no competition because there is no market transparency at all. There is also no pricing transparency, the prices aren’t even posted and you can’t know what anything costs before you get the bill. How can there ever be competition in that environment

Most medical decisions are not shopped. It has nothing to do with competition. Quality of care is first and foremost for me. I want to live costs be damned. Only rarely will cost come into it as a decision for me. Only on things I don't need. This is for both emergency and non-emergency care. I don't know of anyone who seriously and consistently looks at costs when making medical decisions. I usually have higher priorities.

You don't know people who live near the margins then. Cost was pretty much the primary decider for me prior to making a decent living, so much so that I put off rotator cuff surgery for 10 years because I couldn't afford to have it done, no matter how much I "shopped around".

I think the posters comment was in a vacuum- I, too, did not consider cost when I got a surgery.

It was part because costs aren't transparent, but also because the costs were the same to me after deductible.

The only truly cost aware folks in the system would be Amish on community insurance funds or similar odd edge cases

The vast majority of medical care is not life and death. It is completely routine. It's getting vaccines, it's getting checkups, it's getting antibiotics for your sinus infection, it's getting treatment for sprains and strains. You're not going to be price-conscious on any of that? Do you go to the mayo clinic for your annual physical?

Yes, I actually go to the Mayo Clinic for primary care. It is actually cheaper than the rural doctors and hospital I live near. There is no shopping around for cost. The decision is do I trust the doctor or not. I drive to Mayo because the local doctors make to many mistakes and are not familiar enough with a variety of ailments.

The market is so non transparent you can’t shop for quality or cost. The system forces you into random provider to optimize allocation efficiency not cost or quality. You can resist that but it often means everything takes significantly longer

> Most medical decisions are not shopped .. Quality of care is first and foremost for me

So you shop around for quality? That is still shopping around.

If customers could try to get the highest quality for their money that also works, doesn't have to try to find the cheapest.

There is no competition because there is no market transparency at all.

Wrong, there is no competition in medical care both because in the end it's not possible for lay person to make informed decisions about the spectrum of treatments available when they are under time pressure and there is no way to have choice when you have a single hospital serving a substantial area (and other ways that health care is a "natural monopoly").

Those are additional problems in some situations. But most hospital care is not immediately life threatening and people in major cities have access to 4-5 different hospitals sometimes more

They do post the prices. But how often do you actually go through and examine each code to see the prices? How do you know when you go into a hospital from an ambulance that your issue is due to say, kidney stones and not cancer?

Price transparency works in an environment where a consumer knows all of the choices they have to make. For medical issues we can often only guess when it comes to critical problems, and even other protracted issues that you are aware of can be complex and hard to navigate. If you think price transparency will help then I reckon you're someone that hasn't actually been critically ill before.

The prices they post are not real prices. Nobody pays the price posted. It’s just a thing they do for compliance reasons

Okay if your argument is that they're lying about prices, then how is price transparency going to help? They will keep lying about the prices, or obfuscate prices further by breaking them down into smaller pieces.

Like the reason why insurance companies etc don't care about price transparency is because of the above. You're demanding something that won't work and will never work, unless the government steps in and says XYZ must cost YYY.

They aren’t lying so much as having different price tiers for everyone. The published price is the maximum price, it’s paid for only by auto insurance companies typically. Everyone else has a negotiated lower price.

Medicare prices for all would be a solution for example but doing so would both explode Medicare and bankrupt the hospitals

I don't see a reason pharma industry couldn't function like food industry.

Do you want anyone to be able to create their own pharmaceuticals?

Actually yes.

Fair, but it's a very long way to that in terms of boxing the required capabilities (ignoring regulation). So for that to have an effect on markets in pharmaceuticals will need a lot patience.

You argument only holds true for insurance.

Europe arguably has more competition in the healthcare manufacturing and labor sectors than the US.

Europe has the same pharma and device companies. Im not aware of any country that has price controls.

What Europe has is purchasing controls. If something is too expensive, the national insurance plans simply dont buy it and dont provide it.

This is what the US lacks.

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