How to Charge $546 for Six Liters of Saltwater
nytimes.com
nytimes.com
In a completely deregulated free market, it is even more in the hospitals' interest to form a price-fixing cartel. Any new player in the market trying to set reasonable market prices could be excluded through market pressure tactics (eg, tell distributors don't sell to them or our cartel will no longer use you).
It seems to me that the parlous state of the US healthcare system is in fact a perfect demonstration of the dangers of a completely free market, and claims that "oh no it's not actually free enough" are merely handwaving.
There was a similar thread a few weeks back:
https://news.ycombinator.com/item?id=6258597
It'd be great if the HN community started throwing out some ideas for disrupting this behemoth.
Good luck with the same at hospitals though...
>When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000.
http://www.nytimes.com/2013/07/01/health/american-way-of-bir...
Even in the suburban areas I've lived in, for us that meant a "selection" of between 3-4 potential clinics, not exactly a very wide choice (and completely based on where I lived so it could very well have been that I would have been selecting from 4 of the worst clinics in the whole state).
When my wife was pregnant, at some point we got billed several thousand dollars for a procedure the insurance company refused to cover. She called the insurance co., and they (I think) recoded the procedure to something that cost a couple of hundred dollars and was covered to boot.
It seemed like there was a bunch of new employees on both sides who were learning as they went (and pressing random buttons). So forget in advance, pricing was hard to find out even post facto ;)
If you buy a bad TV you can return it and provide a bad review, so next time you shop from a better store. If you buy a car and it turns out to be a piece of shit, you just lost lots of money. It will take you years to recover and save for a better, but you still can.
You can't get your life back, you can't get your health back sometimes, you can't return your dead child back. That's the problem.
Plans are deliberately priced to be confusing to compare prices; plans are frequently updated to cause people to be stuck in win-optimal contracts; consumers are gouged on some items (see bizarre cost of sms in UK); and companies collude to defeat market mechanisms - see the use of area codes in auction bids as a method of communication when frequencies were auctioned off.
I'm a bit confused how anyone using a cellphone could chino otherwise.
We choose between what we have, not what is the best or the right thing to choose.
So because in this day and age it's convenient to have a cell phone, the choice to do without one is not a free choice. And because one doesn't have an unlimited number of carriers to choose from, that choice is also not a free choice.
I'm using free choice in a different way, perhaps. To me, unless someone puts a gun to your head (so to speak), every choice you make is a free choice. That doesn't mean the choices are without consequences, or that they are necessarily good for you.
So you are free to not choose one but the consequences are huge to most people in fact to big.
It's not a rational choice as the free market philosophy claims, its a choice thats primed by whats considered desirable at any given time.
cell phones opportunistically exploit that innovation.
the fact that you get great hardware for a tiny monthly cost is just proof that they're over charging most people for something else.
You are getting fleeced!
Those are examples of designed markets, even though there are accompanying technologies, as is the current mobile telephony business. Now guess who stands in the way of implementing those changes?
Most hospitals will not, however, tell you how much a procedure costs making shopping around for non-emergency procedures impossible. Combine that with the usual low deductible health insurance plans and you've driven out any incentive for the consumer to even attempt getting a good deal.
Home Depot would happily gouge you if they could form a cartel and gain enough control of the supply chain.
This is, after all, the reason we tend to avoid government monopolies if we can avoid it. It's not just that government is inefficient, it's that monopolies are inefficient, whether "private sector" or otherwise.
There's nothing peculiar about medical supplies that make them easy monopolized. Pharmaceuticals and medical devices (neither of which are the topic of the original post) enjoy patent protection, but there are often many out-of-patent substitutes available.
Doctors are limited, but that is primarily because the state makes it illegal to practice "medicine" without either being a doctor or being supervised by one. Much other scarcity stems from this one, e.g. limited insurance options because it's difficult to create a physician network.
There are absolutely free-market-advocates out there who would remedy price-fixing problem by allowing self-taught people practice medicine. That should increase enough market-entrants to break any cartels we see.
I'm not one of those advocates, because I see some sort of quality guarantees as helpful in this arena. But there are lots of aspects of the healthcare market that could benefit from more market-like behavior, whereas there are other aspects which could use less (i.e. more regulation). We need nuance in order to make progress.
I do very much believe more consumer choice for non-urgent care would be helpful, i.e. lab choice, hospital choice, a menu of drug options (ratings, side effects, out of pocket cost). This is controversial for a number of reasons, but after considerable, I believe this would have significant positive impact on the overall efficiency of healthcare.
You might if you were carted into a Home Depot unconscious on a gurney, handed a non-returnable light bulb and stuck with a bill for $6,844.
You're just convinced it's not.
Some very high-end custom-designer fashions might be excluded, but if you're buying off-the-rack (or mail-order/online) clothing manufactured in mass, you're buying a commodity, in the sense of a largely undifferentiated item. The label is the _only_ item of distinction (and not even that when you're getting grey-market goods).
Incidentally, look up "commodity" in your dictionary, it doesn't mean what you think it does.
A commodity would be silk, or cotton - the raw fabric used as base materials. What you then do with those materials to increase their value directly changes them from commodities into products.
Put another way - gold is a commodity, as is silver. Jewelry, however, is not. It can't be a commodity if the material has been changed into a diversified form to increase its value - it has to be raw in order to be a commodity.
Check your dictionary.
Billing the saline to you is an accounting device. It has no meaning--it's just a component in a service that isn't a commodity at all.
There are dozens of options and hundreds of styles and the end customer can try them on and decide what works for them.
When you are at the emergency room and are given treatment with no opportunity (and in most cases, ability) to compare the various treatment options, then, yes, you tend to expect the caregiver to not mark something up 10, 25, 100X.
This isn't true at all, not even from a standpoint of brand and marketing. Most people cannot tell the quality of a garment by comparing alike items. Most people are not aware of fashion trends outside of what they see for sale at stores in their price point.
free markets are really good at efficiently allocating resources in certain types of markets, and not so good in other types of markets
A record fine for a CRT price-fixing cartel that ran from 1996-2006:
http://www.bbc.co.uk/news/business-20608949
And an LCD price fixing cartel that ran at the same time:
I like to think of myself as a free markets guy, but driving healthcare via the market seems like the worst, most cynical application of the concept possible.
If consumers make bad choices, don't they eventually learn to make better choices?
Even if we assume that consumers will learn to make good choices, that would require that they understand their choice was a bad one.
This is an A-B-C problem (antecedent + behavior => consequence). The consumer must first recognize that a negative consequence has occurred, and then determine whether it was their behavior that was flawed (they made the wrong choice) or a flawed antecedent to that behavior (they'd made the right choice, had their assumed knowledge of the situation been accurate).
Consumers don't do this though. Studies have repeatedly proved this (e.g. the very large effect of marketing and advertising on selection of products of otherwise equal quality).
Consumers may make decisions that are non-harmful (i.e. they got about the same result but simply paid more) but they certainly do not make decisions that are optimal.
In the healthcare "market", they don't.
Health care stopped being a free market when government stepped in. Then it because burdened by politicians creating a system which favored whomever was giving them money and votes.
I... I just... wow.
I have read a lot of wrong things on HN, ranging from the merely misinformed to the willfully ignorant, but this might take the cake.
http://en.wikipedia.org/wiki/Medicaid
http://en.wikipedia.org/wiki/Hipaa
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordab...
This is kind of like condescendingly asking someone to provide a counterargument to a proposition that the Earth is completely dry land.
So.. are you merely misinformed, or willfully ignorant?
That's fine. The sentence I'm objecting to is about the US healthcare system.
...
"I never said Instagram hosts their own services!"
If commenters took a minute to think about other potential meanings before going off on some misinformed rant it might make for a more productive debate.
Then again pigs might one day fly.
I think that (or something like it) would have been a much clearer approach.
At what point does the number of people who correctly understand it come into play? If 6 people don't get it, but 6 people do, is it still the fault of the author? What about 60, 600, 6000, 6bn?
Surely if only six people out of the entire population of the world misinterpret a point, and everyone else gets it, then it must be the due to the prejudices or poor comprehension skills of those six.
You may or may not agree with that conclusion, but it's a far more plausible view for someone to hold than what you seem to have thought the original poster meant.
The commenter actually says exactly that...that the US healthcare system is (in fact) a perfect demonstration of a completely free market.
Saying that something demonstrates the dangers of x by saying that the things that are wrong with it are features of it moving in the direction of x is not the same as saying that the thing is x.
I could say that something nearly catching fire and getting badly scorched is a perfect demonstration of the dangers of fire, but that would not mean that I think that the thing has actually caught fire, it just means that I am using a perfectly normal rhetorical device to describe that I think that the fire is a danger.
"perfect demonstration of the dangers of a completely free market"
You:
"perfect demonstration of a completely free market"
Do you see where the difference is?
Absolutists about free markets are at least being purposefully obtuse if they don't admit that they think vendors should win every advantage from irrationality, inelasticity, and information asymmetry, plus every transitory advantage as markets get dominated for a supposedly temporary interval and for supposedly salutary purposes.
The above, combined with a bias toward investor-owned enterprises over co-ops, customer-owned, and nonprofit enterprises is what brought us to a place where market liberalization only hardens the position of incumbents.
The problem here is one of incentives. If I promise to pay you for mowing your neighbor's lawn, and he rarely reviews what you're doing and I rarely check with him, suddenly mowing the lawn gets really complicated and expensive. If, on the other hand, you walk next door and solicit the neighbor to mow his lawn, suddenly it's a very simple transaction. The difference is one of incentives. If the goal is to provide mowed lawns, the neighbor is the guy responsible. If the goal is to provide a rationale for writing a check? Heck, I got all kinds of easy rationales handy. I can play this game all day.
It should be illegal for anybody to pay a medical bill except for the person receiving treatment. If you want universal coverage, that's fine: pay the patient and have the patient pay the hospital and doctor. Once you begin to incentivize other players besides the patient, you're going to create a mess. I'd also recommend completely unbundling hospital services. Patients should be able to buy materials and services on the open market -- and keep the savings they make doing so. Hospitals should provide clean, sterile rooms for independent specialists to work, not form a pricing cabal controlling anything that happens inside the walls and incentivized to game the system.
Perhaps I've misunderstood you here but in my opinion the way healthcare works is sort of the opposite of a free market and if a free marketplace for health services were allowed to exist then things like $500 bags of saline solution wouldn't exist.
However, the substantial majority of healthcare services provisioned are non-emergency.
It is absolutely possible for us to have a freer market in those services (Lasik procedures are just one frequently cited example) and IMO that would be a huge improvement over the current Frankenstein system we have today.
- The U.S. is some sort of ungodly hybrid system, a muddling of free market and tightly regulated ideas, and has very bad outcomes for the amount of money we spent.
- Everyone else has gone away from a market system, more toward a regulated system, and experienced better outcomes.
It's possible that also walking away from the other end of the market and relying on the invisible hand to administer your IV will work, but it's not a notion supported by much data - it's a free marketeer leap of faith, and it's in an industry where many of the assumptions needed for a free market (information symmetry comes to mind immediately) don't exist.
The US system didn't become this way because the people involved thought it was a great idea, it became that way because of perverse incentives through which services are paid for.
All you need to do is look at how providers act and you can tell what they make money on and what they don't.
Why do you think nearly all hospitals have emergency departments? It's not because they are providing a service to the population, it's because it's a great source of profit. Same thing with cardiac centers.
- Airfare
- Cell phones
- Many telecom services
- Banking & finance
- Healthcare
- Lawyers?
- Accountants?
There is no "perfect information" allowing consumers to choose the cheapest price. As the article points out the pricing structure is very opaque. Not to mention the "consumers" want the best product regardless of cost, after all we are talking about their lives here.
Given the lack of free market conditions operating on these healthcare providers it is only logical that they would behave like the extortion rackets they are.
In 35 states you can't do that. Existing facilities are protected, and you'll need to establish a certificate of need[1] showing that business won't be taken away from existing facilities. The somewhat tortured logic is that they would then have to charge remaining patients more which would raise costs for everyone so this is a cost saving measure.
Like many parts of US business it is good old fashioned protectionism, and not free markets.
I live in a country that has been rated the freest economy on earth every year since 1995 [1]. Low taxes, small government, minimal regulation. So what does healthcare look like here for the average person? $13/day. Got a sore finger? $13/day. Intensive care? $13/day.
There is a significant parallel private system that offers all the luxuries and perks that a free market can provide (no waiting times, private rooms, choice of doctor etc.). But it competes with the public hospitals for buyers. In providing a competing alternative, I would speculate that the public system limits the type of monopolistic situations that can arise.
No system is perfect and clearly there are enormous differences between the US and elsewhere, but it's interesting to note that the "freest economy on earth" has universal public healthcare, in addition to a freely competing private system.
[1] http://en.wikipedia.org/wiki/Index_of_Economic_Freedom
[2] http://en.wikipedia.org/wiki/Health_in_Hong_Kong
[3] http://www.news.gov.hk/en/record/html/2013/04/20130409_19040...
A good example is the infusion of drugs. Medicare pays ASP+4% (just cut from +6% due to sequestration). If you're a clinic that doesn't get a discount on their drugs (mostly community based clinics) you're often paying more for the drug than the gov't pays you (it's a net loss every time you prescribe the drug).
However, the gov't does pay a lot to infuse the drug. The result? Providers everywhere were starting their own infusion clinics and making a ton of money on it. The profit from infusion clinics would be used to offset the loss from the purchase of the drug. CMS clamped down on reimbursement for infusion services recently, but it's still a profit center.
This happens all the time in the US healthcare system.
So what do hospitals do? They jack up the price on every item they possibly can. Of course insurance companies know what is up, so they negotiate much better rates for all of the items. However, for those who are uninsured, they pay the charge master rate which is very inflated.
The problem with the US healthcare system is not that's a free market, because it isn't. The problem is that's not a free market and it's not a fully regulated market, it's something in between. So what happens is that some regulations are put in place, some of which cause certain procedures to be unprofitable, so providers simply shift those costs to the un-(or less) regulated prices.
I'm not using it as a political term, rather to describe our current, quarter-profit-maximization system driven by the stock market and public company board + CEO directives for how to run a company.
It's great for efficiently using capital to exploit existing innovations but it's really bad at things like investing in the public, social good of things like healthcare.
When my son jumped off the couch and cut the inside of his mouth open, I wasn't asked my opinion on treatment. And if I had been asked, I would have simply said "you're the physician, do what will make him better the fastest." The same would have gone for when I had pneumonia or had to get a tetanus shot after getting fishhooked while surfing. My goal is simple -- recover the best the fastest.
How does one legitimately comparison shop for a baby delivery? Imagine, for instance, Hospital A says their births average $20,000 and Hospital B says their births average $30,000. Which rational prospective parent chooses the $20,000 option?
Hospital care is not like buying a car, where most people can consider themselves educated enough to make a decision based on competing factors -- perhaps I'm willing to give up some handling for a lower price or I'm willing to sacrifice fuel economy for more power.
The average person knows nada about the medical practicalities of giving birth (or treating pneumonia, or even stitching gums) so they cannot make informed decisions about what are reasonable tradeoffs.
As other people have said, medical treatment is an inelastic need. Parents don't say "you know, I'm cool with 50% less effective treatment for my child at 50% of the cost" and people don't say "you know, 90% functionality of my leg will be just fine if you can bring this in at a discount."
So not only do you have a lack of informed customers, you have a lack of choice in outcomes. A free market solution for medicine is a fairy tale spun by people of certain social and political persuasions.
For something like "set this broken bone" sure, it's difficult to talk about the price for this risk vs. that risk. But for the liters of saline used during the procedure? That ought to be trivial to analyze. Yet it is not.
The nurse says $500.
Option 1) You say "no way, I can't pay that." The nurse shrugs and says "well, that's what it costs for IV solution here."
Option 2) You say "holy hell that seem expensive for a bag of salt water." The nurse shrugs and says "well, that's what it costs for IV solution here."
Option 3) You say "I'm really not comfortable paying that. What other treatment can I get?" The nurse shrugs and says "sir, this is the standard protocol for treating acute food poisoning. We put a saline solution into your arm via IV to replace your fluids. There is no alternate treatment. We're really busy in the ER, so I need to put this needle in your arm or get to another patient."
Now let's add a functioning market as you allude to:
Option 3, redux) You say "I'm really not comfortable paying that. What other treatment can I get?" The nurse says "well, we also have this other saline solution for a buck." You, reasonably, say "wait, what? Why is this other one 500 times cheaper than the first one?" The nurse shrugs and says "no idea, I don't make them. They both seem fine to me though." You, still being reasonable, say "then why is one so much more expensive than the other? Will the cheaper one do just as good a job as the expensive one?" The nurse shrugs her shoulders and says "look, I can't promise anything one way or the other. We default to the more expensive one but if you want the cheaper one, that's your choice. It's probably fine. Just sign this form that you're opting for the cheaper solution."
What does a rational person with zero context choose?
How did you and your spouse decide on an ob/gyn when you were expecting your kids? How did you decide on a pediatrician after they were born? Would you be able to rate your experience with both/either after the fact (ie, did the experience live up to the reasons you chose them?)? Would it be possible to use such ratings along with costs to at least create some measure of efficacy for the specific providers or their hospitals/clinics? The outcome may not be a perfect solution, but it at least gives people some data points if they are interested in comparing doctors/clinics/hospitals for whatever their needs are.
BUT ... there is only one hospital here and all of the doctors are part of the same system. So, although we could "comparison shop" for our physician, this had no effect on what we would (potentially) pay.
Leaving aside that, people do in fact make medical decisions based on cost. For example, for angioplasty there are two options - a medicated stent and a non-medicated, regular stent. The medicated stent is more expensive than the normal one. When it came to choosing one for my father, I chose a medicated one only because I was paying through insurance. But many of the patients out here in India don't have insurance. In that case there is a definite probability that a lower cost one will be chosen. Another example is dialysis. The frequency at which people perform dialysis is directly related to cost and affordability.
It is not always a given that patients would go for the absolute best.
1) (Cheapest) local
2) (Middle) nitrous oxide
3) (Most expensive) IV sedation
In my case my oral surgeon basically said I'd be nuts to go with option 1, since my surgery was complicated.
1) Unlike medical procedures, for dental procedures it's pretty easy to get price quotes from multiple dentists: they will tell you their sticker price if asked. They will also give you the procedure code so you can ask your dental insurance (if any) to what extent that's covered so you'll know what the actual price to you is. People will in fact comparison-shop for major dental procedures, based on cost, dentist reputation, etc.
2) The situation with emergency or time-sensitive procedures (pneumonia, tetanus shot, cut inside mouth) and scheduled non-emergency ones (hip replacement, say, or laser eye surgery) is a priori quite different. It is in fact possible to sanely price-shop for hip replacements if people are willing to tell you prices and there is reputational data available. Unfortunately the medical establishment works hard to prevent both. Laser eye surgery is a particularly interesting case, because there _is_ freely available price information there; you may want to look at what's happened to its price over time. Learning as much about such a procedure as people tend to know about buying cars is not actually all that hard: people don't know that much about cars and there really isn't that much to know about some of the fairly standardized scheduled procedures.
3) People do in fact do the "90% functionality at much lower cost is just fine" thing all the time, with glasses (e.g. buying reading glasses at CVS instead of getting a prescription pair), dental procedures, and some scheduled medical procedures. You're right that "50% less effective treatment at 50% of the cost" doesn't happen much, though. Instead you get 100% less effective lack of treatment at 0% of the cost....
4) Since you brought up baby deliveries.... Sorry, pet peeve. If a hospital is charging you $20000 for a low-risk birth with no complications (which they definitely do!), that's an excellent indicator of how broken the system is. If you shop around for how much that sort of thing costs with people who specialize in low-risk births (birth centers, midwives), you will discover that the typical price for birth plus prenatal visits with no complications in the US is in the $3-5k range. Of course such a setup will not do the various wholly unnecessary things that will be done in a typical hospital birth setting, nor will it be subject to typical hospital billing practices.
5) A good bit of care in the US is end-of-life care, where it is in fact quite possible to make price/time tradeoffs to some extent, as well as comfort/time ones (e.g. hospice vs aggressive cancer treatment that might prolong life for a few months) and people who are in a position to make that choice can in fact make it in an informed way.
In practice, what we call "medicine" is a bunch of separate services that have totally different economics, often being bundled together with completely opaque pricing put on top. For some of them, there is lack of informed customers and lack of choice in outcomes, as you say. For others one or both are present. And even today some parts of "medicine" (e.g. scheduled dental cleanings) work quite different from other parts (e.g. pediatric well-child checkups; try to get a price quote from a doctor for one of these!) for no particularly good reasons that I can see.
The "right" solution to this problem is unclear to me, unfortunately, because as you point out there is a fair amount of emergency medicine where a free market cannot possibly operate. A good example of such a thing is the total lack of any possibility of a free market in emergency ambulance transport, from the patient's point of view. We should stop our attempts at a fake free market in those areas, but we should also try to create actual free markets in medicine where possible. And for quite a few things I believe it is in fact possible.
Usually, the patient just ends up going to the specialist their primary care provider referred them to or the closest one home. Until the quality/outcome data is made public there is no hope in steering people to better hospitals/providers.
There are some attempts lately in freeing up this information but I guess only time will tell how effective they will become.
On the bright side, it will only take one good health insurance company (I am thinking more like the type of disruption that a "Virgin" like company may bring to the table) to start using this data and driving some meaningful change.
Even limiting them to 1000% markup would be "wrong".
Yay 'murica.
Be sure to donate blood while you are waiting for your loved ones in the hospital so they can sell it for 10000% markup too.
The example case was a guy who'd developed an auto-retracting needle, and was screwed out of business by some major manufacturers pressuring hospitals not to buy it.
Does anyone have a link to that article?
"How the medical supply industry blocks device startups from selling to hospitals"
http://www.washingtonmonthly.com/features/2010/1007.blake.ht...
https://www.cia.gov/library/publications/the-world-factbook/...
Ah, I see. It's only en vogue to complain if I don't know anything at all about the constraints of the domain and am pulling stuff out of my ass. My bad.
It's a loaded question in the sense that I've been at various hospitals and they always talk about their budget shortfall which is in part due to non-reimbursed care provided to those who cannot pay and/or have no insurance. But it's also not a loaded question in the sense that I want to understand why people would think hospitals don't eat costs.
Also, hospitals will bill whatever amount they can get reimbursed. Most insurance companies have contracts with hospitals where they only get a fraction of the billed amount. The rest is written off by the hospital. Uninsured patients can usually work out payment plans for lower amounts as well. That said, healthcare in the US is still pretty damn expensive.
Reduce the malpractice payouts and shield doctors like other countries do. Make the government absorb more of the costs for care. The price could probably be cut by 200 to 300 bucks.
[Citation needed]
2. How much progress in the world is stifled by powerful incumbents blocking competition? Taxi lobbyists tackling Uber, car industry impeding mass transit in LA decades ago, etc?
http://www.bloomberg.com/news/2013-08-13/florida-pharmacists...
The TLDR is that an independent pharmacist treating AIDS patients got run out of business by price fixing competitors. He got the last laugh and sued on the behalf of the government and has so far collected $597M in awards (the government has collected over $3 billion).
The behavior of these (very large) firms was outrageous:
> For example, Abbott Laboratories (ABT) sold its antibiotic Vancomycin 1 GM FTV to customers for $4 a dose, according to a joint Justice Department and Ven-A-Care lawsuit. Abbott reported the cost to pricing publishers as $72.48 -- 18 times the actual amount, the lawsuit says.
This is likely going on for other types of drugs and then also in every other segment (medical devices/supplies being a biggy).
What do you think the bar is for entering the market of providing water for injection? Who's there to make it costlier, maybe the insurance oligopoly can hold some of the blame for this as well...
http://www.zorotools.com/g/00107210/k-G4226537?utm_source=go...
The the majority of the cost of capital, dealing with regulation, and other "justified" increases is absorbed into the manufacturer sale price.
Any suggestions HN readers?
These are non-technical people, who went to school mostly for biology and chemistry, or for the lowly clerks, and secretaries in your doctor's office, maybe two years of community college, with an associates degree in communications maybe. On average, take a random sample of the people who do the paper work for the lofty, priest-like physicians. Ask them what AES is, or what a SHA hash is, or even what SSL and TLS are. I guarantee you, that you'll get a blank stare.
They know how to use the systems they're provided with, like they know how to open a bag of Oreo cookies. The doctors know how to pay IT professionals for services, like they know how to write a check, and know to procure electronic systems like they know how to make down payments on their Mercedes. You can be sure that they know how to shred all those e-mails that they print out and read over their morning coffee.
It's only as private insofar as no one is supposed to look. This protects people under the law, in that, as a rule, certain information is not to be used as criteria for making certain business decisions. But this is merely a bureaucratic honor system, and it doesn't mean that people aren't aware of things they aren't supposed to know about. The information itself, frequently, isn't particularly "secure" according to more strenuous information security standards. Your credit card transactions are safer than your HIPAA information by a longshot, but mostly because there really isn't any sort of criminal profit motive behind obtaining and using that sort of information.
Perhaps a similar approach could work for IVs.
Even if one is willing to accept them into one's general worldview... First principles - like "government is wasteful" - only go so far in the face of conflicting data. And there is a lot of it on the topic of healthcare systems.
Don't simply blame "regulation" either. Many industries are regulated, some heavily so, and still manage to produce companies that are profitable and efficiently deliver good products.
I don't think we'll see a real solution to the healthcare system in America until we stop treating it like it's just like any other industry.
Politics is the art of figuring out when to burn the extra resources on the government method because all of the other available methods are even worse.
However, naive grass-is-greenerism is more of what I was railing against.
"The social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s.... Health policies mainly promoting equal financial access to healthcare have little chance of abating health inequalities. "
It also appears to not look at ethnicity at all in that study.
It is basically saying that it isn't enough to make healthcare available, you also have to get people to use the service in other ways than mere affordability as even if something is affordable a lot of people will still not bother and claim that they think it will be unaffordable.
Results: After making adjustments for numerous individual socio-economic and health characteristics, we observed a higher occurrence of reported forgone healthcare among people who have had financial worries during adulthood, a life-course experience of physical, sexual or psychological abuse; who have experienced childhood difficulties; who have expressed a low degree of sickness orientation, a high worry/concern about and a low self-esteem
I happen to believe the french system is better than the US system (as the US system is right now) but I don't personally believe that it is fundamentally the best system or in any way fundamentally better than a free market system (to include medical charities). But what I think is completely misguided is to think that the French system is absolutely equitable, infallible, or transposable to the US.
You started with a comment about killing off 90% to achieve ethnic homogeneity and when pressed on the point said that the French health system can't possibly manage to treat poor people of Arabic extraction. Forgetting ethnicity for a moment would seem to be to remove the prior context that people were replying to.
Also, you then after saying to forget ethnicity start saying that we know socio-economic is a codeword, presumably meaning that you have no intention of leaving the subject of ethnicity.
Also you are claiming systematic avoidance of the French healthcare system and that it has failed in it's attempt to treat people fairly. Now, it obviously is not perfect, nothing is, however to paint that study as evidence of systematic avoidance and failure, rather than room for improvement seems churlish.
Failure is when you spend the most money, but still rank thirty eighth, rather than when you are the fourth biggest spender and rank first.
Personally I just think that you are an ideologue on this. Show me a country that gets good results from unregulated private medical care plus charities. Who builds the network of A&E departments in that case?
I am also not convinced that the French medical system is sustainable. We are getting a snapshot in time, and since no economy today is based on a system that doesn't borrow money on interest, (versus spending only what it takes in through taxes), kicking payments to the future could mask unsustainability, ultimately resulting in a spectacular collapse of the system. In other words, today's French citizens could be living in borrowed luxury that will absolutely slaughter tomorrow's. Again, this is not to say that the US system is sustainable (it obviously isn't).
Either of those people could get hit by a bus at age 20 and need life saving surgery and massive help learning to walk again. This isn't particularly about morals of ownership, this is about pragmatic ways of spreading risk.
I don't personally care what the political setup is and I think there are numerous ways to achieve spreading medical risk, but I have yet to see a country that is getting good results from just private industry plus charity.
If you think you know how it could work and that there would be an improvement in medical outcomes and general equitability from your plan over the other systems now in effect, then that is excellent news and you should detail it in an academic paper and tell the world.
However, given that you are stating that you are an ideologue on this, then you are starting with the answer you want to end up with and just trying to work out how to argue it.
If you want to say that is all I am doing as well, then fair enough, all I can say is that I am fairly certain that is not where I am coming from on this, while noting that you openly admit it.
Funnily enough, medic in French is an Arabic loanword, toubib.
Also, I am not sure how you think the French health system works, but at every level through it there are enough people of Arabic background in it that your idea of there being massive differences in health care for people of Arabic background in France seems unlikely. It is true that there will be instances of racism, however I think that you are pretty far off the mark here in general.
"Ultimately, different ethnicities get different diseases, too, so the bureaucrats in charge of deciding what gets covered and to what extent are basically institutionalizing racial privilege."
There is some variation in susceptibility to disease between different ethnicities, sure, but there is such a large and established Arabic population in France that it would make no sense for the health service to be acting in the way you are suggesting.
Also what particular diseases are you talking about? As far as I am aware there has been so much mixing between Arabic populations and European ones over history that the differences are not really all that great, especially when you look at the differences in care required anyway for two individuals from the same ethnic background.
At the end of the day, given that the French health system gets some of the best ratings in the world and that France also has a very large amount of people who are not of European ancestry, it would be very hard for there be a vast gulf in care based on the ancestry of such a sizeable percentage of the population, otherwise France simply would not hold those ratings.
Out of interest, how much time have you spent in France? I have been there a few times, some of my family have lived there for several years and I am currently sharing a house with someone French, who is not of European background.
This is easier said than done. The link between socialism, still a profane political philosophy, and municipal health care is too strong—the time it would take to switch it over is be on the order of election cycles, not years. Granted, we are already on that road, but it's going to be a long time before any mainstream politician embraces it.
Absolutely not, and and "socialist" is not the same thing as "socialism" at any rate. The only people who hate the idea are the hardcore capitalists, most notably those who profit from the current regime (industrialists and drama-fed parasites like the media and politicians), but the fact remains that nationalized health care is a feature of pretty much every single country with a higher standard of living than the US.
Well, them and voters.
End the idiotic "billed rate" vs. the "negotiated rate" nonsense.
Include patient transportation in the equation. If singular pricing isn't attainable, a local hospital's care is too expensive, and the patient can receive similar care at an alternate location in a cost-effective way - cover the transportation cost under their insurance.
Tort reform. Liability insurance premiums for health care professionals is as crazy as the price for the care they provide. This is as big a problem as the price of a bag of saline.
I know these aren't the answers - but pricing of services is key to the problem, and the Affordable Care Act did little to get that under control beyond attempting to move more individuals under the umbrella of insurance and outside of emergency care.
Preferably with a lead pipe.
The price for one oxygen condenser is covered after a victim(patient) pays for the device for around half a year.
Looking over some others I know, they are all going through this same company. Referred to them by each of their hospitals.
I cannot fully explain the scheme worked out from the hospitals, but I know it depends on having the often confused patient signing a bundle of documentation while he is being led out the door. I read over the documents and it seemed fair, I just had no time to research all that was needed. My father was in full legal control and he himself just simply followed through with what the hospital asked.
Fuck you, Airway Oxygen.