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Comment by ctdonath | Hacker News Reader

I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades, bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home in perfect condition save for a narrow scar, a daily pill and ticking like Captain Hook's crocodile - that's a heckuva process to go thru, it went spectacularly well, and I'm alive in great shape, heck yeah it was worth half the price of my house. They brought me back from the dead, how much is that worth?

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You are succumbing to the common fallacy of associating cost with quality.

Last week, my dad (who is a doctor in Turkey) was telling me about a new study that compared the cost of healthcare services in various countries around the world and the satisfaction of patients. He said that the USA ranks close to the bottom of the index, meaning that considering how much American patients pay for healthcare, their level of satisfaction is incredibly low.

This is why "healthcare tourism" exists and is dominated by American patients.

You are succumbing to the common fallacy of disassociating cost from quality.

Yes, a good successful job can be done much cheaper - but, on the whole, the odds of success & quality degrade fast when less is spent. When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns. "Healthcare tourism" by Americans includes the ability to identify & access those pockets of excellence; those areas in general may not enjoy such inexpensive quality as the norm, nor have easy access to excellent outliers.

BTW: Americans (I speak as one) are a chronically dissatisfied bunch. Having remarkable access to excellence in all things, we bitch & moan about how it isn't oh so slightly better. Yeah we complain about the cost of healthcare, and at the same time demand the absolute very best, quick to sue the pants off any doctor whose work fails perfection standards by any statistically normal degree when something could have been done better regardless of extreme cost. I suggest caring little about opinion polls where objective statistics are available.

>>When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns.

There is no evidence that this is the case. Note that the vast majority of the cost is due to the massive complexity of the system: every party involved - and there are many - wants their cut, and they don't necessarily contribute to the well-being of the patient or the efficiency of the process.

You don't get payed for how smart you are or how hard you worked. You get paid for how big of a problem you fixed for somebody, and how much they are capable of paying you. That's why good doctors and lawyers get paid so well. Dying or going to jail are big problems, and people will spend a lot of their money to avoid them.

This is exactly what is wrong with health care in a free market.

if you had an operation with a 10% chance of failure for $5000, would you take it?

What if you could spend twice the money and cut your risk down to 5% if you quadrupled the expense? $20000, even I'd take that option for you, as an objective observer.

what if you could cut it down to 4% for $50000? Ok now it's getting a little silly, but it's still your life.

what if you could cut it down to 4.75% for $100000? Don't you deserve the best? I mean this is your LIFE. In anything else this would be a silly investment, but your life? You can't take chances. It's a bizzare choice, but really the only rational one in your situation, you have to survive.

So the thinking goes, we are incapable of negotiating for our own lives. To the point where it blinds us, by choosing that expense you doom the ones who can not afford it.

This is exactly how economic reality works.

Yes, your very life is subject to the costs of diminishing returns. We can't guarantee everyone the very best because it costs too much, and we can't force people to spend less on their life than they can afford and choose to spend because it's not yours to distribute. Tough choices aren't easy.

The problem is that people want 0% risk and have someone else pay the infinite price tag.

choosing that expense you doom the ones who can not afford it.

Do I?

Elsewhere in this thread is a post about a surgeon greatly improving the lives of those who cannot afford it by buying a used laparoscopic tool and creatively applying it. I've had laparoscopic surgery; thanks to the high price I & others pay, the laparoscopic instruments used may have replaced the very same one that Indian doctor is using. Far from "dooming the ones who cannot afford it", the system which regularly replaces top-end tools makes entirely acceptable equipment very affordable to regions which can't pay top-end prices.

Disallow me from paying an extra $50,000 to get that extra 0.75% survival odds, and the surgeon very well may not buy that next-generation laparoscopic tool and, as a consequence, sell the still-perfectly-good used one at low cost ... making it possible for another doctor to increase the survival rate for his patients by 5%.

Are you sure that the constant push to the top-end lowers average prices? If we spend all our time making lamborghinis, that means that the old lamborghinis will be cheaper thus cars more affordable? I doubt this strategy. Make more laproscopic tools. Rather than tell your economic inferiors to live off your scraps.

The healthcare market cannot chose to capture deadweight losses. People would view health care professionals treating rich and poor with different medical standards as an abomination. There is no Healthcare basic edition, Home basic, Home premium, Professional, Ultimate. If you raise the general cost of a heart surgery from $50K to $55K, and lower the mortatilty rate from 5% to 4.5%. Does the amount of people you save with that 0.5% worth the amount of people who can't make it to 55K, but could make it to 50K?

Are you sure these numbers are in your favor? Well, I mean, yes of course they're in your favor, I mean everyone, as a whole.

This is exactly what is wrong with health care in a free market.

What free market are you talking about? Medicare effectively controls the prices of medical procedures (since insurance companies reimburse non-Medicare recipients on the basis of tables the government puts out). It also controls the number of doctors (it does this by limiting the number of residency slots - see the Balanced Budget Act of 1997). The FDA regulates everything from the development and testing to packaging and marketing of drugs, medical devices and related products. Due to federal regulations, physicians are not permitted to discuss prices with one another. There are countless regulations that manipulate health insurance. And don't forget the 1943 IRS ruling that permanently established the link between health insurance and your employer.

And this is all stuff that's mostly decades before Obamacare. That just scratches the surface. For example, I didn't even mention HMOs, which were created under Nixon via another set of regulations intended to control costs for things Johnson had done.

A free market in health care? If there's one thing American health care has not had in the last 50 years, it's a free market. Sure, it has been slightly freer than in other countries, but that's not saying much.

They brought me back from the dead, how much is that worth?

I'm glad you're well. How much would it be worth if you'd had to sell your house and/or declare bankruptcy, while knowing that similar-quality treatment was available for 1/20th the price in India and elsewhere?

Not just being snarky. Since leaving corporate America (and the healthcare plan) to start my own thing, I think about healthcare costs a lot. For starters, the lack of transparency or price-competitive marketplace, for such an expensive purchase, is mind-blowing.

The For Sale sign would have been up before I went into the OR with nary a second thought. Worst case, negotiate arrangements for $50/day for the next 10 years.

Yes, health care costs a lot. Miracles are expensive.

It's not a miracle. It's impressive, but you're mischaracterising it.

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