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Comment by reaperman | Hacker News Reader

> The ability of an insurance company to unilaterally deny treatment, or determine what type of treatment a patient receives, is obscene and should be categorically illegal.

I emotionally agree with this, but I don't have a good answer for the following situation:

1) A company develops a new, slightly more efficacious treatment, patents it, and prices it at some completely absurd cost (say, $1 million/month for daily pills).

2) Doctors understandably prescribe this treatment because it's slightly more efficacious than the pills that cost $16/month.

Where would pricing pressure come into play here? If insurance companies can't say "No, that price is ridiculous and we're not paying it." I'm honestly wondering what the solution for this would be.

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Don't run your healthcare as a for-profit system.

even a non-profit system has to control costs.

Sure, but single-payer government healthcare has an enormous ability to influence the cost in the first place. Outside of a treatment that demonstrably has a true cost to manufacture (when also accounting for R&D) that is within that ballpark of say, $1MM per dose, I suspect you’d find the government finding ways to bring the cost closer to reality.

Also, rarely is it the case that such expensive treatments are needed by more than a fraction of the population. I’d say there’s an argument to be made that we all aught to be okay with a small fraction of people getting healthcare that far outstrips their contribution via taxes – given that we never know if that one day may be us.

>I’d say there’s an argument to be made that we all aught to be okay with a small fraction of people getting healthcare that far outstrips their contribution via taxes – given that we never know if that one day may be us.

Yes, but that still must have limits. Society certainly should not pay one trillion dollars to care for a single patient. That’s too inefficient.

for every single patient, sure, but if that's the cost of the treating the first patient (it being a revolutionary new procedure and all), and it goes down from there, then why shouldn't we?

Paying to develop and scale a significantly improved treatment for a condition that affects many people is an altogether different proposition.

> then why shouldn't we?

Ultimately, there's only so much economy to go around. What percentage of it are you willing to dedicate to treating that one condition? What about everything that can't be funded or produced as a result of that allocation?

One of the key ways that single-payer government healthcare influences costs is precisely by refusing to offer treatments that are too expensive for the benefits compared to the next-best option. In particular, the NHS in the UK - which is often pointed to by US politicians as an example of how single-payer can save money - refuses to offer treatments that cost more than a relatively low amount per quality-adjusted life year saved, which is specifically illegal for US healthcare providers and insurance companies to take into account.

Yes, I was just thinking of an acquaintance's similar cancer situation in the UK. The NHS denial of the more effective but more expensive treatment was intractable, and so they paid for the treatment out of pocket through a fundraiser and saved her life. Their fundraiser was successful enough that they were able to give some money to other UK residents in the same situation. In the US I think they could have at least switched jobs to get it covered if they couldn't hack the appeals process.

Does co-insurance help with this problem? e.g. if the patient is responsible for 10% of the cost of the pills, then the patient is motivated to choose the cheaper pills without the need for a long bureaucratic process with the insurance company, and the doctor just has to present both options

Healthcare costs for advanced procedures and medicine and equipment are so high that the amount 90% of people can afford to pay is inconsequential to the whole cost, hence the use of insurance companies (which are not just selling insurance, but acting as the healthcare recipient’s agent in negotiating prices and appropriate levels of healthcare, ideally). Obviously, the reality leaves much to be desired.

But that is the purpose of high deductible health plans, to give healthcare recipients an incentive to to visit cheaper healthcare providers or accept generic medicines.

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