Why an MRI costs $1,080 in America and $280 in France • Hacker News Board

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

#181

Post by nooop » Sun, Mar 04, 2012, 6:08 PM UTC

yummyfajitas wrote: post #8

dhughes wrote: post #3

If there was medical procedure that would cost a lot in a hospital an MRI would not surprise me, it such a large powerful, power hungry, complex device I can't see how it couldn't. I wish each person could get access to an MRI each year it would be nice to track your health visually.

The capital costs for an MRI, while large, are not the biggest part of the price. I had an MRI done in Pune (with a good machine, 3T/32 channels) for 6500rs/$130. Labor costs are a biggie. In the US, you need to pay technicians high US salaries, in the $60-70k neighborhood from what I hear. In Pune, the technician is almost certainly poorer than 95% of Americans. The high ratio of capital costs/labor costs also cause…

Probably some of the "top 1% person in the US [that] gets $384k/year" do not get it only because of being highly qualified and hard working...

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

#182

Post by sunir » Sun, Mar 04, 2012, 6:09 PM UTC

iwwr wrote: post #77

tzs wrote: post #16

What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways. For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the governm…

Don't forget that in Canada it's illegal to be a private medic. Medical services are ostensibly free, but rationed through queues. If you have a medical condition that's not immediately threatening, you may find yourself waiting for years for treatment, or have to go across the border to buy it.

Canada has a public health insurance program. Medical services are privately provided except for hospitals which usually are partially government subsidized on top of the health fees due to the high capital costs of building them.

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

#183

Post by rsynnott » Sun, Mar 04, 2012, 6:09 PM UTC

J3L2404 wrote: post #123

tzs wrote: post #16

What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways. For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the governm…

First of all: "the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket" Although it dovetails with the well worn narrative on HN, this comparison fails due to the level of care. Also, from the article comments: "There are just a couple problems. In 2009, the French Society of Radiology equipment in France was critically undermining care, an…

> Although it dovetails with the well worn narrative on HN, this comparison fails due to the level of care.

The context is purely the model of provision; level of care isn't addressed.

> Second, some of the development of MRI technology happened in Britain. Most was performed in the U.S. Who is paying for the cost of development of this and other new technology and drugs? It's often not the people in places like Canada and France, where government controls hold down prices. Most of the cost of research and development is paid for by Americans. We pay perhaps five times more in the U.S. for some procedures than people in France pay, but the technology might not exist in the first place if we didn't pay this disproportionate share.

This is an interesting point, in that much of the technology is actually developed outside the US, but the very high prices which Americans pay may be funding some of the development. That said, drug companies, for instance, only spend in the region of 12% on research, less than they spend on marketing. This marketing spend is disproportionately targeted at the US, as it's one of the few countries which permits heavy marketing of prescription drugs directly to normal people.

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

#184

Post by rsynnott » Sun, Mar 04, 2012, 6:12 PM UTC

danmaz74 wrote: post #75

anateus wrote: post #71

Earlier quoted context omitted.

Similarly MedLion ( http://www.medlion.com/ ) provides primary care in Santa Cruz and Silicon Valley for $59/mo + $10 visit in part by not accepting insurance (they claim on their website it saves them 40% in costs). Insurance works great for catastrophic things, just like car insurance and then it clearly makes sense to make it universal. If you could only buy gas through your car insurance--who occasionally would d…

I'm all in favor of universal health care, but having universal (private) insurance without a collective bargaining system raises a lot of problems. For example, here in Italy car insurance is mandatory, but people choose where to make their car repairs, and prices aren't regulated in any way. The results: Once I went for a repair, and got quoted something like 150€ - I told the repairman I thought I was covered by m…

> "You know sir, with insurances we have all those additional costs...".

Two possible issues here. First, it _does_ cost more to reclaim payment from an insurance company than to get it from the consumer. There are the forms to be considered, and also the fact that insurers often pay substantially in arrears. Also, did you end up paying cash? Some providers of services like this will prefer a cash deal, as they do not necessarily plan to declare it.

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

#185

Post by rhino42 » Sun, Mar 04, 2012, 6:17 PM UTC

matwood wrote: post #126

Joeri wrote: post #95

Earlier quoted context omitted.

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. Tort reform is a diversion, not a solution.

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. The cost to avoid lawsuits adds up with a lot of tests that are not needed. Doctors end up doing whole batteries of tests on everyone to avoid the 1:1000 or higher chance that the person in their office with a headache really had an aneurysm and get the doctor sue…

I have anecdotal evidence to back up these claims: my mother is in internal medicine and my father is a surgeon. both have practiced defensive medicine and my father has complained about how common an occurrence it is on a regular basis.

Many tests, drugs and treatments have been applied in the name of defensive medicine.

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

#186

Post by rsynnott » Sun, Mar 04, 2012, 6:21 PM UTC

asmithmd1 wrote: post #39

High health care spending is yet another way the US subsidizes other countries. From the article: "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 the past 30 years have you heard of any medical innovation…

> In the past 30 years have you heard of any medical innovation or drugs coming from anywhere other than the US?

Er, yes, _many_. See some of the recent work in HIV and cancer drugs, for instance, along with many more conventional drugs. It _is_ true that pharmaceutical companies (most of which are, these days, highly multinational) derive a lot of their profit from the US market, but they spend a lot there too; the industry spends more on marketing than research, and this is disproportionately targeted at the US, as it's one of the few countries where one may advertise prescription drugs directly at the general public.

> Of course the MRI machine was itself invented in the US

Hmm? Very arguable, that one. While its medical application seems to have been the product of an American academic (note, academic, not medical device company employee), NMR imaging (renamed MRI for medical purposes, presumably due to the unpopular word 'nuclear' in the original), was previously made feasible through work at the University of Nottingham, in the UK.

Like many inventions which came as a series of parts, it's rather hard to point and say 'Mr X invented this'; there are at least two American contenders, one British, and one Soviet.

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

#187

Post by Deinumite » Sun, Mar 04, 2012, 6:24 PM UTC

iwwr wrote: post #77

tzs wrote: post #16

What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways. For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the governm…

Don't forget that in Canada it's illegal to be a private medic. Medical services are ostensibly free, but rationed through queues. If you have a medical condition that's not immediately threatening, you may find yourself waiting for years for treatment, or have to go across the border to buy it.

As a Canadian, the stuff that I see other people telling _me_ about my healthcare system makes me upset.

As others have said, it's not illegal to be private in Canada.

Everyone who seeks medical attention at a hospital is sent through triage, you are right. If you don't have a life threatening problem you won't be treated first, but saying "sometimes people wait a years for treatment" is just hilariously misleading.

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

#188

Post by rhino42 » Sun, Mar 04, 2012, 6:26 PM UTC

tsotha wrote: post #143

malay wrote: post #128

Earlier quoted context omitted.

They are certainly lowering the prices, hence the constant back and forth (literally for 30 years straight) of local market consolidation between the buyers (health insurers) and the suppliers (hospitals/physicians). There are legal fights going on all over the country because of all the pricing issues; Pittsburgh is a great example of how the dominant insurer (Highmark) simply refused to pay the dominant provider's…

>The problem is actually pretty simple: hospitals are terrible at cost accounting and totally game it. It's not that they're terrible at cost accounting. The problem is the hospitals are required to provide care to people who can't pay, particularly in the ER and obstetrics. So costs are shifted from other departments to pay for these services. That's why people who are trying to hold down costs by zeroing in on this…

This is very true. It was actually the argument that convinced me that a public provided healthcare system (at least for preventative treatment) is an awesome idea.

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

#189

Post by rsynnott » Sun, Mar 04, 2012, 6:28 PM UTC

underwater wrote: post #66

Cadsby wrote: post #52

Earlier quoted context omitted.

This is because no one is quite sure what it should cost. Literally. The hospital will try and charge whatever wild number they can get away with, and the insurance company will negotiate it down to whatever they feel they're willing to pay. My wife is a nurse and has seen this play out multiple times with patients and their families. Just to give you an idea of how disconnected the price is from logical factors, con…

People argue that the current system works because capitalism is more efficient. But when the prices are hidden from the customer by either fudging prices or hiding costs behind a fixed fee in the form of insurance the system is broken.

This seems to be one of the fundamental misunderstandings people have about capitalism; they like to think of it as a form of virtuous economic freedom. A market system, however, only works with reasonable information. In this case, it is apparently of benefit to the providers to treat them as trade secrets, but the system will operate more efficiently if they are forced not to do so (as they are in most places).

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

#190

Post by rsynnott » Sun, Mar 04, 2012, 6:30 PM UTC

dutchbrit wrote: post #84

And that's why Obama's public healthcare idea was good.

The watered-down implementation, though, may not stand up; as mentioned in the article, it will do little about prices besides force provider disclosure (itself an important step, as markets operate more efficiently when it's known what things cost, but not really enough).