Why an MRI costs $1,080 in America and $280 in France | Hacker News Reader

Why an MRI costs $1,080 in America and $280 in France

washingtonpost.com

43 pointsMaven91191 comments

As a French citizen who's enjoyed the goodness that is subsidized health care, it needs to be stressed that all this has a cost for the country.

The vision that taxpayers support a system where everyone is granted access to next-to-free / affordable health care has a natural cost in certain areas.

Sure it's great when you're both poor and sick cause you get to be treated like everyone else, you get the day care for your kids, you get the MRI's, the cancer treatment, you're being taken care of at the ER etc.

But at the same time, everyone has to realize that this has a cost in terms of taxes. Taxes for companies, home buyers, CEOs, businesses, cigarettes and alcohol, gas, etc.

It's the old chasm between putting the emphasis on the individual or on the nation/country as a whole. America has traditionally favoured private/capital-oriented solutions so far for most of its services (postal services, health care, public transportation, part of its schools, water, electricity, Internet infrastructure, etc.) and was thus able to keep the burden of taxes lower for individuals.

If it were to move to a system where everyone pitches in for cheap state-driven services, the money would have to come from somewhere and it would be sure to somehow stifle economic growth in certain areas (see the economic situation of France or other countries where the involvement of the state is still strong).

TL;DR: The idea of cheap MRI is nice on paper (and I believe it to be awesome in practice), but there's no magic wand to make that happen, the money has to come from somewhere and it requires that a whole country accepts paying more to the state to get more at the other end, a paradigm shift that will be tough to swallow for the USA given its economic culture.

Health care taxes on cigarettes... morbidly hilarious.

Do people think health care taxes on cigarettes is a bad idea? As a smoker who pays extremely high taxes on cigarettes here in the UK I have no problem with them.

It makes total sense to tax the hell out of it, because it causes a very real health care burden. Doesn't change the dark humor of it though :)

The problem with taxes on cigarettes (as I see it) is that most of the time it's not proportional to one's income. A tax that is not progressive is inherently unfair IMHO, as it places a heavier burden on the less fortunate. EDIT: Someone mentioned that cigarettes are a life choice but I personally believe that to be more of a nice theory than a fact. In reality smoking is huge among people with lower income, due to lack of education about the risks, cultural factors, advertising, etc. (see http://www.gallup.com/poll/105550/among-americans-smoking-de...). As a result, a higher burden is put on people who tend to smoke more on average, which are apparently the very same people who don't have too much money to begin with. Still their mistake to be spending the little money they have on a drug, but it's one of those "easier said than done" things in my opinion.

You don't have to buy cigarettes though. They are a life choice.

Smoking is a choice that makes someone more likely to have health problems later. Under nationalized health care, taxing cigarettes is just aligning incentives.

Health care costs in the US can have the same effect on the population as a tax even though it does not get go through the government. The goal should be to lower the healthcare cost per person, not squabble about who is paying.

That's the kind of reasonable debate about values and priorities that would exist in a sane system.

But the US has a certifiably insane system. The government spends more on healthcare per capita here than the government does in France. To be clear: that's excluding private spending.

Some of that is certainly driven by a higher GDP per capita, but it's still ridiculous even when accounting for that.

We might not need the government to fully subsidize healthcare to improve things though. Prices are set so high that hospitals - even nonprofit ones - have huge profit margins (this is better stated in the original [now-paywalled] TIME cover story: http://www.time.com/time/magazine/article/0,9171,2136864,00....). So even without the government paying for everything, there could be regulation to control prices set by healthcare providers.

You overlook that US Americans still pay a lot more per capita (or as a fraction of GDP) than citizens/residents of other countries: http://en.wikipedia.org/wiki/List_of_countries_by_total_heal...

While you may be paying more in taxes, the average American will in the end pay more for healthcare (as a combination of insurance and out of pocket expenses). That this goes to healthcare providers and private insurance companies does not matter much; it comes out of your paycheck either way. If you're really uncomfortable with paying taxes to the government, you can pick the German system (where public health insurance is handled by non-profit sickness funds) or the Swiss system (where health insurers are private companies, but get told by the government what they have to offer and how much they can charge for it; they make money from providing non-essential addon insurance). In the end, though, either is still equivalent to a single-payer system in practice.

A major reason for the higher efficiency is that a single-payer system (economically, a monopsomy) can negotiate much better prices; prices also tend to be much more transparent, whereas in the US American system, the actual costs are often obscured. This is because normal market forces tend to work poorly in an unregulated or loosely regulated healthcare and health insurance market (e.g., ask yourself how much are you willing to shop around or bargain with a doctor when your health or even life is on the line).

This article didn't seem all that great. It just claims "the prices are higher" without any substantive recommendations on how that problem can be solved.

Nonetheless, it does make one interesting point:

This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.”

In other words, the low prices for health care found in other countries is, in part, subsidised by the American consumer. As a result, it would stand to reason that if price controls were implemented in the U.S., it could result in less medical innovation or rising prices elsewhere in the world.

Also, this article doesn't explain the price of MRIs at all. Is the price higher due to higher worker costs, more expensive machines being used, more expensive facilities or more pricing power on behalf of the providers?

I thought the implication from the comparison with other countries is that it's primarily pricing power: i.e. profit for the providers. But I agree that the article doesn't address the title very directly.

This Planet Money podcast gets into it somewhat: http://www.npr.org/blogs/money/2013/02/26/172996963/episode-...

Part of the problem is that few people even know what the prices are.

Not to mention prices are and always have been variable depending on whether you're an individual or insurance company.

Also weirdly enough according to the article's chart MRIs have a relatively reasonable spread.

> This article didn't seem all that great. It just claims "the prices are higher"

They buried the reason: “It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.”

Profiting off of the sick and injured has zero shame in the US. In fact, if you can drive the patient to bankruptcy, then you have maximized the take.

For some reason, there is no outrage. Previous generations would have used the word "profiteering", but the word seems unfashionable to apply in modern times to medicine or the military.

Health care companies seek a profit because innovation takes capital investment, and the only way to build capital is to make a profit. The article admits to the value of this when it talks about how U.S. consumers subsidize innovations that have global benefits (like MRI machines).

I totally disagree with the idea that health care companies actively seek to drive patients to bankruptcy. Can you provide any proof of this other than your own opinion?

One example: One of Elizabeth Warren's crusades before the banking crisis exposed that 46% of all bankruptcies circa 2007 were medically induced.

http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

It isn't exactly news that the industry maximizes profits.

The mere fact that you chose to write "Health care companies seek a profit because innovation takes capital investment, and the only way to build capital is to make a profit" is indicative of the problem. It's almost as if you can't imagine any other means of solving the problem.

I don't think you're alone either. In quantitative medical rankings, the US is 33rd in life expectancy and 34th in infant mortality (behind Cuba!) yet is #1 in per-capita spending.

http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...

http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor...

46% of all bankruptcies circa 2007 were medically induced.

There were obvious problems with Warren's methodology. If I live in a system with excellent government healthcare, and I end up paralyzed, my family might still go through bankruptcy because they've lost their primary income.

The number is more like 1/4 than 1/2. 26% of bankruptcies have medical debts exceeding $1000. Obviously that includes someone owing $4000 to a dentist as well as someone owing $450,000 to an oncologist, so the real number is some portion of 26%.

> The number is more like 1/4 than 1/2.

Great. So the number of people that have been profitteered into bankruptcy is only 1/2 of what I mentioned.

It doesn't change the basic fact: Profiting handsomely from the sick and dying used to be considered unethical. Now, it is "just business".

The real question is what percentage of medical patients go bankrupt at all.

There is no other known means of solving the problem of funding long-term innovation. This was one of the major lessons of the 20th century.

> "In other words, the low prices for health care found in other countries is, in part, subsidised by the American consumer."

What you'd expect is that the research takes place in the US due to some level of higher profits, but it's far from clear whether that level ~= our current level.

Absent any determination of discrepancy between those two levels, while we can still say it's a part of the puzzle, we have no idea how large a part.

And given that a higher GDP country will tend to be the more profitable place to do any front-end research/initial rollout anyway, it wouldn't seem that researchers would need any additional profit premium to prefer the US to, say, France [1].

So while data may show differently, I certainly wouldn't expect that factor to explain any of the discrepancy between what we pay as a percentage of GDP and what France pays.

[1] In general: people in larger economies tend to spend more for things. So net profit tends to be higher there. So things tend to get researched/introduced there first. And no other industry seems to require anything close to the additional profit premium that the healthcare industry sees, to do that research/introduction here first. (auto, energy, tech, etc) In fact, the degree to which industries go elsewhere tends to hinge on massive government subsidies designed explicitly to offset this natural reward structure.

Yes, it's extremely hard in America to choose to have a European level of health care, where not everything is done to keep people alive at all costs, damn the bills and damn quality-of-life and damn patient wishes to the contrary.

One quote from the "How Doctors Die" I linked to elsewhere on this page (heavily trimmed for space):

He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. .... Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. ... Then I turned off the life support machines and sat with him. He died two hours later. ... Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill.

I think it's very important that people be allowed to spend their own money on what they want, because that's where the innovation will come from that will eventually be commoditized for everyone else. But sometimes last year's pill is good enough.

I have another post for reasons why health care is so expensive in the US (a recent infographic time magazine): https://news.ycombinator.com/item?id=5382451

> Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say “no.”

But there are other products that we absolutely need to stay alive that don't suffer the runaway prices we see in healthcare.

The best example is food. You can't say no to buying food.

So why don't food sellers have us over a barrel? Because consumers see prices and force the many providers to bid competitively against each other.

My point is that inelastic demand is not the fundamental cause of high costs in healthcare. It has much more to do with the many layers of abstraction we place between patient and provider that prevent price signals from passing through.

Food and healthcare are both inelastic demands, yes. But that doesn't mean they are comparable. I have 8 hours between hunger spikes; plenty of time to shop around. I know when I am going to be hungry, and I will be hungry again soon.

The issue as I see it with healthcare is the the nature of the beast itself. When you are bleeding from the femoral artery, you don't have time to shop around, and you don't know when it will happen. Additionally, it is a rare event, unlike your drive for food.

When you have one of the big ticket items that they make the big money on, such as cancer, you have a lot of time to shop around.

I disagree that healthcare is an inelastic demand, it's obviously quite elastic. There are levels of service and of care. Take something like a broken femur for example. One person may opt for a cast and crutches and little else while someone else may opt for a motorized wheelchair and extensive hands-on rehabilitation therapy afterward. Or look at, say, prosthetics. There are amazing cutting-edge almost bionic prosthetic hands and legs these days, but does it make sense to bankrupt the public in order to guarantee everyone access to those who might want them? Or just look at something as simple as diet and exercise (what we know to have one of the biggest impacts on health), one person may be able to afford a personal chef and dietitian who can plan all their meals and to hire a personal trainer to keep them in shape, but many wouldn't be able to afford that or even necessarily want it.

The notion that everyone should be guaranteed equal health outcomes is a very seductive one, but once you start digging into the details it falls apart quite rapidly.

"The notion that everyone should be guaranteed equal health outcomes is a very seductive one, but once you start digging into the details it falls apart quite rapidly."

Falls apart exactly how? Seems to work fine in just about every country that's tried it (which is most of the first world). Mind you, it's not really the health outcome that's guaranteed (obviously that's going to depend on individual constitution, age and lifestyle) but access to the same level of care is seen as a given. In my town recently there was a minor scandal when a pro hockey player showed up with a game injury at a local emergency ward and went to the head of the line. The hospital had to scramble to explain that his injury went through normal triage.

You talk about bankrupting the public, but clearly it's the far more expensive US system that is bankrupting the public (along with providing worse outcomes overall). For those of use who have grown up with publicly funded healthcare, a fully private system seems primitive, barbaric and inhumane equivalent to having firefighting or police services exclusively for those who can afford it.

This explains why Canadians, including MPs, sometimes come to the US for care, and why the Queen of England went to a private hospital when she developed gastroenteritis, right? It's silly to imagine that there isn't or shouldn't be a relationship between level of care and cost of care, even if we desire for the costs of most common life-saving care to be "socialized" in some way. Demanding that all care be the best possible care is a non-starter because that's clearly not financially feasible. Some folks can afford to spend multiples of the average per capita GDP on their health care, and that's just not physically possible for everyone to do.

As for your straw man about a "fully private system", I made no mention of that, nor have I advocated such. I was merely making an isolated point. You can put your pitchforks back in the shed and put down your "libertarianism = somalia!" signs.

Our system is clearly broken, but the idea that other systems aren't also broken in various ways is naive. There's no silver bullet that will solve the problems of cost and access to health care, and that includes the extraordinarily naive idea of just making "government" pay for it all.

This is where the concept of health care "insurance" makes sense. We have car insurance and homeowner insurance for the same reason--to cover sudden, unexpected events.

But modern health care "insurance" also covers the payment of goods and services that do NOT meet sudden and unexpected events. A huge portion of the health care industry services chronic ailments. Hunger could be considered a chronic ailment--it is not urgent, but must be managed at all times.

Yeah, I agree. Things like birth control seem entirely at odds with the "insurance" model. I haven't a problem with subsidized birth control, but maybe such services should be part of a separate program?

The true costs of food are hidden in the heavy toll it takes on our environment, the poor or illegal labor situations used to harvest it, and the subsidies given out by the the government.

One doesn't generally have a sudden and unexpected need for a very particular type of food that only relatively few specialists know how to produce.

But this is not where the vast majority of health care costs come from. They mostly come from the care of chronic ailments.

Exactly. As an example: One does not comparison shop for an ambulance service after a car accident, nor a surgeon after arriving at the hospital.

And those charges for blood transfusions: Anyone up for a startup to find the lowest bidder?

The relevant question is: what is keeping the supply of specialists from growing to meet the demand?

The AMA is essentially a guild. Everything it does in the name of quality is also a highly-effective way to keep wages high for its members. And that's hardly a coincidence.

Could an innovative medical school train a particular kind of specialist to be just as effective in half the time, at half the cost? We'll never know, because that kind of innovation is illegal.

The balance between cost and quality is not black and white. Plenty of patients might very well prefer to trade off one for the other. Today they have no choice -- there is only one standard, and the providers have every incentive to make that standard as expensive as possible.

The very next sentence points out that the customer may be passed out and unable to form any opinion.

Just reading your quote, though, (I read the comments before the article) I thought that the article was going to talk about how hard it is for even informed people to opt-out of expensive procedures. There was a news story just a week or two ago about a nurse refusing to perform CPR despite 911 demands, but the home the patient was in was set up to explicitly not perform CPR.

Ezra Klein has linked before to "How Doctors Die". Here is the last HN talk about it https://news.ycombinator.com/item?id=5104430 (it has links to the prior talk on HN) Even doctors have to jump through incredible hoops to avoid ending up getting drastic procedures done on them, and even then there is no guarantee that the doctor in charge won't override your wishes and hook you up instead.

First, it is good to look at this on an international perspective, but an entirely separate article can be done on why an MRI costs $1,080 for a patient with insurance and the same treatment would be arbitrarily more for an uninsured patient usually about 4x as expensive. This issue has gone to court in California (2006-2008) resulting in over $1 billion dollars returned to uninsured patients because Courts found hospitals were illegally "price gouging" uninsured. However, price gouging uninsured is a practice that continues around the US, for example in September I received 17 stitches from a FL hospital and the bill was over $12,000 because I am uninsured. I recorded the entire event on my phone including asking how much the stitches would cost and the staff telling me the bill would be $2,000 if I were insured. I challenge the bill since I was quoted $2,000 for the treatment and my bill was $12,000 and when I produced the video of the staff acknowledging different price structures for insured and uninsured the hospital immediately agreed to cover my entire bill.

Second, I can not believe the Washington Post would publish an article titled "Why an MRI costs $1,080 in America and $280 in France", "America" really? I try to never comment on a spelling or grammatical error, but honestly we are talking the Washington Post who should know to use "US" not "America".

Is that why the US has four times as many MRI machines per person?

http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/...

And has no queues for MRI scans, where France has a 32-day mean waiting period?

http://mjperry.blogspot.com/2007/09/canadian-medicine-is-sic...

http://sante.lefigaro.fr/actualite/2011/05/10/10863-irm-dela...

Can it really be called cherry picking if you only pick one cherry? At least make an effort.

MRI exams, 2009 :

- US 91.2 per 1000 inhabitants

- France 55.2 per 1000 inhabitants

Better usage ratio => lower price

And to make an equally relevant point: more MRIs doesn't necessarily equate to better health outcomes. It depends on who is getting them, and how likely they are to actually be sick.

Lots of rich people getting marginally useful MRIs in the USA may be an inferior system to everyone having access to MRIs but fewer being done in total.

It's also symptomatic of a shortage. Being able to meet everyone's needs every time means keeping certain overcapacity.

Bigger installed base => more capital costs to be paid for.

Trying to roll down medical costs to one- or two-line sentences is really dangerous with the US health care system, because so many things you could normally expect in a functioning economy aren't there.

In fact, increased access to medical devices and procedures may drive costs up with no change in patient outcomes. This was a pretty well-discussed article in economics circles a few years ago that talks about the phenomenon: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_...

We do get something for our expensive MRI machines (lower wait times), but I doubt anyone, or even the invisible hand of the market, decided it was a good trade-off. It just happened.

Also see Time's extensively researched "Why Medical Bills are Killing Us" http://healthland.time.com/why-medical-bills-are-killing-us/

the tl;dr of it: hospitals are charging the uninsured exhorbitant markups over Medicaid (which they bitch about, but they actually do well enough that they advertise to Medicaid patients) because they can. Without pricing information (which they hide as much as possible), every emergency is a miniature monopoly. "Non-profit" hospital administrators have every incentive to expand the facilities/prestige of their institution, so they act like the most rapacious "for-profit" corporations imaginable.

before clicking on this post to read it and even still after reading it I think the true reason for this can be summed up in a single word "Litigation"

As someone who has been in court rooms and seen the amount of litigation that businesses deal with in America I would find it hard to believe it does not play a significant role in the higher prices than places where Class Action Lawsuits and Ambulance chasing attorneys aren't the norm

^^THIS^^

More like 5 words:

Litigation Profit Center Supply monopolies (of hospitals/providers vs insurance)

See: http://www.time.com/time/magazine/article/0,9171,2136864,00....

Wrong guild: http://www.press.uchicago.edu/Misc/Chicago/036480.html, http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort..., http://dartmed.dartmouth.edu/fall05/html/disc_myth.php, http://www.forbes.com/sites/rickungar/2010/09/07/the-true-co..., http://online.wsj.com/article/SB1000142412788732409640457835...

I went to the ER here in Dallas a couple of weeks ago because of some chest pains I was having.

The good news - it's just some stomach acid. ER doctor prescribed Prilosec OTC and sent me away.

The bad news - $4,500 in medical bills for 3 hours spent in the ER. Most of that was spent watching TV waiting for the results of blood tests & x-rays to be announced.

Sprained my ankle very badly on January 1. Had an x-ray (nothing broken, yay). Got some crazy painkillers and some Diclofenac gel. Waited for about 15 minutes. Never saw a bill and didn't pay a dime.

And by that I mean besides the roughly 300 EUR that's taken out of my pay check every month now that I'm gainfully employed. People less fortunate get it for free, of course.

I spent the night in an ER once after being knocked unconscious during a mugging, grand total of 5k which half was for the 8 block ambulance ride. Mugged twice!

All jokes aside I learned the value of employer provided health insurance.

An MRI doesn't have a cost in America. The cost depends on, obviously, your perspective. Are you a patient? If so, are you insured? Are you a hospital? Medicare? What state are you in?

Are we talking cost or are we talking reimbursement?

My thesis: Health care costs are higher in the US largely because the US has more per capita wealth than other counties. Look at per capita spending: http://www.oecd.org/norway/BriefingNoteNORWAY2012.pdf

The biggest spenders are the US, Norway, Switzerland and Luxembourg--the same counties with the highest per capita GDP. Health care is simply something a person will spare no expense on: everybody eventually enters a period of chronic poor health as they age in affluent Western societes, but would pay anything to remedy it.

The giant "insurance scam" that the US medical industry is... By the way, it costs something around $83 in India. Of course we can't compare directly just by converting the currency, but it's also true that a lot of American insurance companies these days pay patients to go and get themselves treated in the best hospitals of India as that (including the trip costs) would still be cheaper than getting themselves treated here.

+1 for price controls in medicine

No way! This will be socialism!

Just like libraries, fire, police, roads, government buildings and the army :)

And, huh, those aren't exactly at the forefront of advances in technology. And they are not necessarily cheap either.

I always wondered if we could run a 'medical service' that was a viable 'public service' alternative to spending time in the military or peace corps. Basically let young people volunteer to be health care workers, give them training, and guaranteed employment for 4 - 6 years. At the end of their enlistment they can go out to the private health care system or other jobs.

Can you imagine the horror of spend a billion dollars a week "invading" a country like Afghanistan and having a 100,000 health care workers on the ground making everyone healthier?

Libraries work ok.

Re police: just reading an article over at popehat.com about how a cop framed someone for a murder and sent her to death row.

Re roads: here in Massachusetts we've got toll roads that spend 80 cents of every dollar collected...on paying the tolltakers.

Re army: take a look at the defense budget some time.

There are some decent arguments in favor of government, but you picked some of the worst.

Would those things be better if they were privately run for profit? My personal opinion is that there are certain things that you can't allow the the private sector to run because it leaves too much room for abuse by individuals looking to make a profit. As a Canadian who's mother is a doctor, the one thing that really bothers me about the healthcare system in the US is that from a business stand point insurance companies are more profitable the more claims they deny, which really doesn't sit well with me. I'm not saying our system is perfect by any means, or that the US doesn't have a high quality of healthcare (if you can afford it). But the thought of someone making a profit on someone else not get a medical treatment that they need leaves a bad taste in my mouth.

Are you suggesting that we'd be better off with private security forces replacing the role of the police and army?

Libraries, police, roads, and the army are great examples in favor of government. All you've done is demonstrate that there are exceptions, as there are to anything.

The defense budget is not an exception to the rule. It is the rule. (Almost the Rule, as in kings and rulers.)

I like the idea of transparent pricing that some surgery centers are implementing. One example is the Surgery Center of Oklahoma which simply displays the prices of their procedures on their website.

This way, people can make informed decisions about their health and purchase procedures at rates far below what is charged through insurance.

"Transparent, direct, package pricing means the patient knows exactly what the cost of the service will be upfront. Fees for the surgeon, anesthesiologist and facility are all included in one low price. There are no hidden costs, charges or surprises."

http://www.surgerycenterok.com/pricing.php

I too like the transparent pricing, CVS Minute Clinics are a great example, if they offer a service it is listed on their price chart.

In FL medical facilities that post prices of their 50 most common treatments are given a discount on their license fee. I think that is great, but you have to laugh at how pro-business states get businesses to do anything pro-consumer.

Separately, under the FL Patient Bill of Rights, even if a medical facility does not post their pricing, if requested by the patient the provider must provide a reasonable estimated charges of such service.

Either that or take away the legally protected monopolies that doctors (licensing of physicians and accreditation of medical schools, both of which are used to restrict the supply of doctors to ensure US doctors are the highest paid in the world), hospitals (certificates of need) and drug companies (drug patents) all enjoy.

If these monopolists didn't have the government protecting them from competition, they would not be able to gouge consumers so hideously.

While I think there is lots of medicine that is wasteful, if your plan is to tell Americans "it is illegal to pay more than $X for procedure Y" it is a complete non-starter.

Because in the US there are vastly more MRI machines and they are newer.

France has 1/3 the number of CT machines per capita and 1/5th the number of MRI machines per capita compared to the US. And the US has the highest number of MRI scans per capita per year in the developed world (4 times more than French citizens).

Stats: http://www.oecd-ilibrary.org/sites/health_glance-2009-en/04/...

So the price should be lower in the US because supply is greater right?.

These numbers alone don't tell the whole story either. In the US total spending on MRIs is higher than in France because there are more machines (per capita) and those machines are generally newer. And this gives patients in the US greater access to MRIs and increases the likelihood of an MRI scan being diagnostic (due to the machines being newer and more sensitive). But note that the number of scans per machine is actually lower in the US than in France, even though you are 4x more likely to actually receive a scan in the US.

So essentially the MRIs cost less in France because they use older, less accurate machines longer. Right?

Japan slightly contradicts your points, having much cheaper MRI scans (~$200), many more MRI machines and scans per capita than the US. But yes, they tend to be less advanced MRI machines (not sure about older/newer). This is all put out in the Planet Money podcast linked just above.

http://www.npr.org/templates/story/story.php?storyId=1205455...

Japan is an interesting example of how interpreting statistics can be difficult. Japan is MRI crazy. It has a ton of MRI machines and people get scans all the time. However, does this lead to better care? As it turns out, a lot of Japan's MRI machines are older and cheaper and in many cases not as diagnostic as newer machines (for any given condition). But Japanese doctors give these scans because it makes people feel like they are being cared for, even when they're not. To a certain degree the same effect is taking place in the US, but I don't think it's nearly as significant.

Perhaps someone should do a study on the placebo effects of MRIs on outcomes...

A doctor I was talking to recently told me that they do way too many scans in America because of liability concerns that don't exist in other countries.

If there is a tiny chance that a condition might actually be something more serious than the obvious diagnosis they will send you in for a scan to be sure even though the doctor "knows" that it's not.

Wait a minute... Are you saying that because French doctors can't be sued for making a mistake they don't order MRIs?

What? you're not saying that? Then why would American doctors order more MRIs? Perhaps to detect those tiny chance conditions, that might actually be more serious? So you're saying that sometimes the MRIs reveal something important about the patient's health? And you're wanting to blame US doctors to find that out? How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"?

I think I prefer the US system in that regard.

Your uncalled-for sarcasm is burying several important points.

First, when doctors in the US are sued they need to show they met the "standard of care." If every other doctor in your community is doing MRIs, you have to do them to, even if they provide no health benefit to the patient. Even if you think that MRIs are leading to worse patient outcomes, that's not the standard you are being judged by.

Second, being sued is a very expensive proposition, even if you did nothing wrong, and doctors are very risk averse of going to court even if they are perfectly confident they did nothing wrong and can prove it.

How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"?

While they can have benefits, all medicare procedures have costs as well as side-effects. In fact, some procedures can decrease patient outcomes, meaning even if they were absolutely free you wouldn't do them. They still get done, because whenever anyone talks about effectiveness research, someone else has a fit. (If Democrats suggest it, Republicans talk about the government getting between you and your doctor. If Republicans suggest it, Democrats talk about how they are putting profits over patient health.)

We can't have the grown-up conversations about what procedures are and aren't worth spending money on, because someone insists that all doctors should "make sure."

I lived in France, and I have relatives, including my sister, who lives in France now (and is a recipient of the French medical establishment's services). I worked for a US HMO for 5 years. I also worked for a US medical malpractice insurance company for 1 year. The points you make are valid, and I agree the system is messed up. Alas, I recognize that all massive systems are messed up and cost a lot more than they should, because large systems introduce inefficiencies. It is possible that the US system is less cost-effective than systems in Europe because of the size of the US population versus that of other European countries. Japan seems to be a hybrid system, and has a population of 125 million or so, but I don't know much about it despite the fact that my wife is Japanese.

In the other large-population countries such as China, India, Indonesia, I don't know that things are any better.

(As an aside, I don't think sarcasm is ever "called-for".)

medicare for everybody!

Do they include the amount the government kicks in to pay for that MRI in France?

I don't see how this is related to Hacker News.

That's an interesting matter and people comment on it. Related enough to HN for me.

We talk a lot about disrupting businesses here; there's a reasonable number of folks in the audience who want to do this to health care. Likely no deeper than that, but understanding the entrenched solutions in a market can be valuable if that's your plan.

I see your point, but I see a lot of non-tech news here. And this opens our eyes to an industry that might need changing (sort of like when pg mentioned that Hollywood is in need for disruption one year ago)

You have some big companies like General Electric trying to do things like improving hospital visits (http://www.gequest.com/c/hospital)..and a lot of people making fitness apps. But not much else then what from what I can see....

Much of the discussion on HN is about startups. Health care costs are a major issue for nearly anyone starting a startup in the US and for most people considering working for a US startup.

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