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How to Charge $546 for Six Liters of Saltwater

nytimes.com

131–140 of 191 posts

Re: How to Charge $546 for Six Liters of Saltwater

#131
post #94
post #58

Earlier quoted context omitted.

Well you can hardly have a free market for healthcare in the first place. A functional market requires that consumers be vigilant and make good choices. That's hard enough without being sick or injured. 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.

With respect, what is a functional market, and why does such a market require that consumers be vigilant and make good choices? If consumers make bad choices, don't they eventually learn to make better choices?

"If consumers make bad choices, don't they eventually learn to make better choices?" One of the assumptions buried in this is the idea that consumers have access to the information required to make such a choice.

In the healthcare "market", they don't.

Re: How to Charge $546 for Six Liters of Saltwater

#132
post #123

Earlier quoted context omitted.

Because they have no other choice. We choose between what we have, not what is the best or the right thing to choose.

If a person chooses it freely, how can you say it's not the right thing for them to choose? Epistemologically, how could you know this?

They are not choosing freely, society pushes them to have a cell phone, and by definition there is no free choice of carriers because the government allocates the spectrum.

Re: How to Charge $546 for Six Liters of Saltwater

#133

It's always in the seller's interest to create a complex and opaque system of pricing, especially when the buyer doesn't even pay for the services. This is why free markets aren't the answer to everything. It's free and open markets that drive efficiency out of any process. 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 rar…

> This is why free markets aren't the answer to everything. 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.

The counter to this argument is the following:

- 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.

Re: How to Charge $546 for Six Liters of Saltwater

#134
post #57

Earlier quoted context omitted.

How do you explain other free markets that obviously deliver quality products at low prices? I don't feel gouged when I buy a television, a cell phone or lumber at Home Depot.

Do you feel ripped off when you buy a pair of Ralph Lauren jeans for $100+ made in Mexico for $7-8?

Ralph Lauren jeans has plenty of competition and the customer is reasonably well informed: * Do you want to pay a premium for brand value? Awesome, buy the Ralph Lauren (or Lucky, or whatever). * Do you want something reasonably durable but cheaper? Buy Levis. * Do you want something cheap but convenient? Buy something at Target or Walmart.

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.

Re: How to Charge $546 for Six Liters of Saltwater

#135
I have two active kids and am reasonably active myself. We have probably received medical treatment a dozen times in the last year, a combination of walk-in clinics, personal physicians and emergency room visits, depending on the circumstances. During these visits, the staff have used equipment, given procedures and prescribed medication and have rarely, if ever, inquired about my thoughts on treatment.

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.

Re: How to Charge $546 for Six Liters of Saltwater

#136
post #135

I have two active kids and am reasonably active myself. We have probably received medical treatment a dozen times in the last year, a combination of walk-in clinics, personal physicians and emergency room visits, depending on the circumstances. During these visits, the staff have used equipment, given procedures and prescribed medication and have rarely, if ever, inquired about my thoughts on treatment. When my son j…

The article focuses on what can hardly be considered a complicated good: salt water. Medical grade saline is highly regulated, and must be one of the most commodity products that exist in the country today. (The article takes pains to establish this.) It takes minimal effort to understand what it is or to compare prices. And yet, as the article says, there is no functioning market for it.

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.

Re: How to Charge $546 for Six Liters of Saltwater

#137
post #135

I have two active kids and am reasonably active myself. We have probably received medical treatment a dozen times in the last year, a combination of walk-in clinics, personal physicians and emergency room visits, depending on the circumstances. During these visits, the staff have used equipment, given procedures and prescribed medication and have rarely, if ever, inquired about my thoughts on treatment. When my son j…

"How does one legitimately comparison shop for a baby delivery?"

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.

Re: How to Charge $546 for Six Liters of Saltwater

#138
post #14

Earlier quoted context omitted.

Copy the health care system of any other rich country. They all get about the same results for half the price or less.

> Copy the health care system of any other rich country. 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.

still a profane political philosophy

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.

Re: How to Charge $546 for Six Liters of Saltwater

#139
post #128

Basically it comes down to we'd rather let people die instead of telling hospitals they cannot do 10000% markup. 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.

Population control, maybe?

Re: How to Charge $546 for Six Liters of Saltwater

#140
post #68
post #57

Earlier quoted context omitted.

How do you explain other free markets that obviously deliver quality products at low prices? I don't feel gouged when I buy a television, a cell phone or lumber at Home Depot.

Cell phones are a great example of the terrible results from supposedly free markets. 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 communica…

The nearly ubiquitous cell phone contract sucks and the operators certainly try to make things confusing but if someone really does want a cheap cell phone and plan they can be had for quite cheap and at not much inconvenience. Drive down to Walmart and you can pick up a $30 cell phone and start using a prepaid plan that costs $30/mo.

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.

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