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

#211

Post by rhizome » Mon, Mar 05, 2012, 2:16 AM UTC

Newgy wrote: post #90

underwater wrote: post #68

Earlier quoted context omitted.

This kind of problem seems fairly widespread in America. Americans are incredibly self-confident, innovative and have achieved a great deal as a nation. They are also extremely proud of their country. Unfortunately this combination often leads them to assume things are good purely because they are American. They tend to accept their own familiar values and ideas and readily dismiss alternatives because that would be…

A major driver of U.S. costs that isn't discussed in the article is our parasite lawyer class, who drive up the cost of insurance for doctors and lead to widespread over-testing or "defensive medicine". Few Americans are proud of our litigious society.

I believe there to be a more concrete cause of US healthcare costs: collusion between insurance companies and healthcare providers. "Insurance" includes both health insurance and malpractice insurance, as well as "providers" being hospitals/doctors and manufacturers of equipment and drugs.

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

#212

Post by mikeash » Mon, Mar 05, 2012, 2:18 AM UTC

foobarbazetc wrote: post #210

nooop wrote: post #176

Earlier quoted context omitted.

Yeah America makes the whole medical R&D, right. Seriously.

Gotta love the level of idiocy in this entire thread. Americans are being really (and irrationally) delusional here, without any data to back up anything being said.

It really amazes me how there are controversial topics where one side never presents any actual facts or figures to back up their stance. I would think that, in the absence of any hard evidence, the controversy would disappear. Yet it seems that anecdote and rhetoric alone are enough to sustain extreme controversy. Both health care and climate change in the US are excellent examples of this.

Edit: the statement about R&D costs is one excellent example of this. This thread is not the first place I've heard it, by any means. It's inevitably framed as the US subsidizing the rest of the world but without any quantitative analysis of it. The assertion evaporates when you actually look at the numbers, of course. Another excellent example was when my father claimed, no doubt prompted by right-wing talk radio, that the life expectancy gap was driven by the much higher murder rate in the US compared to European countries. Upon plugging in the numbers, I found that, assuming an absolute worst case (every murdered American is an infant, losing all ~80 years of life), dropping the US murder rate to zero would increase American life expectancy by six months.

I get how people can be wrong sometimes, but the way it spreads, the way people hear things and never check them or even apply a basic smell test, and the way these complete falsehoods manage to shape national debate is just crazy.

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

#213

Post by jasonlotito » Mon, Mar 05, 2012, 2:30 AM UTC

jaems33 wrote: post #195

jasonlotito wrote: post #135

Earlier quoted context omitted.

Having lived in Canada for 10 years, and recently moved back to the US because of health care, I can attest that while Canadian health care looks good on paper, it's not. Sure, it's there when you need immediate emergency care. But for anything long term, it's horrendous. Autism, for example, is a perfect example, and something I know first hand. In Quebec? The best thing you can do for autistic children is to leave…

Different strokes. Having lived in both countries, my experience in the U.S. was less than ideal. About the same amount of wait times as in Canada, and the doctors I saw gave me very little options as to how I could treat one of my chronic injuries. Never suggested a follow up appointment, physio, or even x-rays/MRI's to get a better look. In Canada, they recommended me a specialist, and I have a nurse at a clinic wh…

Different strokes? Yeah, that doesn't mean what you think it means.

Regardless, it's great that you have a happy story to tell. It's mostly meaningless. The original point is, Canada's system isn't better. It's just another system, with it's own problems. I mean, do you really think your story will change the facts of mine? Does it matter? No.

And, to top this all off, you try to equate "not being impressed" with abuse? Really?

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

#214

Post by prostoalex » Mon, Mar 05, 2012, 2:42 AM UTC

hudibras wrote: post #54

prostoalex wrote: post #31

Earlier quoted context omitted.

The labor costs would vary from country to country. The article questions the price of a service performed by machine (that supposedly differs very little from country to country).

So why doesn't the U.S. allow doctors to immigrate to this country? The median American MD makes $143K; I'm sure that plenty of foreign doctors would love to come here and make half that.

There's no specific provision disallowing immigration of doctors. For obvious reasons it's an occupation that requires licensing/certification, which is more cumbersome than many are willing to consider, and reasonable English, which is usually not a priority in medical schools around the world.

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

#215

Post by dalke » Mon, Mar 05, 2012, 5:54 AM UTC

rhino42 wrote: post #185

matwood wrote: post #126

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. 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.

The followup question is, how much defensive medicine is necessary? If there's a 5% drop in that practice then do the costs from lawsuits go up to compensate? Are we at an equilibrium point, or are doctors doing defensive medicine because the myth of the power of a lawsuit is so strong?

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

#216

Post by jongraehl » Mon, Mar 05, 2012, 7:13 AM UTC

phren0logy wrote: post #102

rdl wrote: post #79

Earlier quoted context omitted.

All the rads I've talked to/worked with hate "screening" MR (or CT! Some morons do CTs for random checkups!) not so much for the cost of the procedure (since they directly or indirectly were getting paid), but because it leads to finding basically insignificant incidental findings which then cause the patient to worry, and/or have unnecessary surgery. The benefits are questionable if anything, but the costs of the un…

Exactly this. Unnecessary imaging needs to unnecessary follow-up evaluations like biopsies which in turn have additional complications. When I was in med school we spent a lot of time in a hospital providing indigent care. We ordered tests that we needed to determine how to treat someone, but not more than that. When I worked in a private hospital, most patients got lab tests done daily, with no specific reason for o…

I don't doubt your experience.

Now, what if imaging were free ... wouldn't the solution be to use it all the time but fix the tendency to over-treat harmless irregularities/growths, rather than using it selectively? Or is fear-of-malpractice preventing this?

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

#217

Post by danmaz74 » Mon, Mar 05, 2012, 9:13 AM UTC

rsynnott wrote: post #184

danmaz74 wrote: post #75

Earlier quoted context omitted.

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 no…

Hehe, in Italy the "do not necessarily plan to declare" is unfortunately all too common. But I'm sure I required a fiscal receipt, so in this case that wasn't the origin of the price difference.

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

#218

Post by danmaz74 » Mon, Mar 05, 2012, 9:16 AM UTC

estel wrote: post #161

danmaz74 wrote: post #139

Earlier quoted context omitted.

I believe that there are some additional costs. But come on, more than double the price... ;)

Depending on the hourly rate, €80 of paperwork isn't all that much.

Ok, probably the absolute value of the (very simple) repair doesn't make this a very significant example. But for sure it was a pretty big overhead.

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

#219

Post by dguaraglia » Mon, Mar 05, 2012, 2:23 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.

I don't know where you get your information tidbits from, but just know this: they are completely, ridiculously, wrong.

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

#220

Post by brohee » Mon, Mar 05, 2012, 3:08 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?"

I know I'm falling for a troll, but even if that number was right, what would be the number removing drugs for mostly purely American issues (drugs for dubious illness like ADHD), drugs for American lifestyle issues like obesity and its consequences (diabete, impotence...)

If your are looking at cure for e.g. pandemics the picture is very different, with Europe very present and emergent economies tackling problems deemed non-economically viable by American companies (e.g. various mosquitoes born disease).