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Comment by ajmurmann | Hacker News Reader

They can't just raise the prices because people will bring their business to the competition. I've personally done this for CT scans. In my local market we literally got a scan for 2k where the hospital we'd usually go to wanted 10k.

The same works for non-emergency surgery as well. Take a look at https://surgerycenterok.com/ it's such a breath of fresh air to see the full price for each procedure right there. People travel there from all over the country to get needed procedures. So competition clearly works but the system doesn't really enable it. For example insurers don't want to work with the linked center because they won't give them rebates but charge everyone the same price. More details: https://www.econtalk.org/keith-smith-on-free-market-health-c...

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> They can't just raise the prices because people will bring their business to the competition.

Not necessarily. They're all under the same pressure. If they all provide similar services with little differentiation, the price will probably settle at a higher level to cover the fixed costs of 5 stores instead of 1.

> In my local market we literally got a scan for 2k where the hospital we'd usually go to wanted 10k.

You kind of get at it below, but I wonder if that's an effect of insurance negotiations (e.g. the hospital you usually "usually go" gave in to insurance discount demands in one area, but pushed back on scans pricing to get the revenue they need to operate).

I do think the totally fictitious nature of posted healthcare prices is a serious problem.

You are over simplifying the problem. First off, the place you quote at 2K is probably an imaging business or part of a larger business that can keep the machines more fully utilized. The hospital has it's equipment to support it's main business. Nobody is going to the hospital for routine imaging. Next, nobody pays $10K at the hospital. Insurance will either have an already agreed to rate or will negotiate it down. As a private pay patient, you can negotiate it down. For planned imaging, a lot of people still won't shop around. Even with a deductible, it should still be the negotiated price. After deductible they all cost the same for most people on insurance. Modern Healthcare isn't a free market. These days insurance has most of the power.

> In my local market we literally got a scan for 2k where the hospital we'd usually go to wanted 10k.

That’s still 4-6x what it would cost at a private clinic in Canada.

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