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How to Charge $546 for Six Liters of Saltwater

nytimes.com

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

#161

Post by rayiner »

tptacek wrote: post #116
rayiner wrote: post #102

Earlier quoted context omitted.

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

A bag of IV saline is a commodity. I would feel ripped off if I bought a bag of white flour and was charged $300 for it, too.

Imagine if Alinea billed you for the flour in your meal at $300 per bag (amortized). Would you feel ripped off?

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.

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

#162

Post by Shivetya »

gnoway wrote: post #58
nikatwork wrote: post #36

Many in this thread are claiming that price fixing wouldn't occur in a "truly free" market. This is misty-eyed naivety. 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 lon…

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.

Regulations usually prevent consumers from making any choice. Regulation can make consumers buy insurance for procedures they do not want, or even physically be able to have. Regulation made impossible to shop across state lines for insurance. Government rules force suppliers to sell services at set rates to one customer and not to another.

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.

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

#163

Post by brazzy »

rayiner wrote: post #161
tptacek wrote: post #116

Earlier quoted context omitted.

A bag of IV saline is a commodity. I would feel ripped off if I bought a bag of white flour and was charged $300 for it, too.

Imagine if Alinea billed you for the flour in your meal at $300 per bag (amortized). Would you feel ripped off? 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.

Bullshit. As per TFA, all services that might conceivably be involved were explicitly charged as well. It is an accounting device in the sense of "Hollywood accounting", i.e. having the sole purpose of obfuscating actual costs while maximizing profits.

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

#164

Post by sourc3 »

jostmey wrote: post #61

And herein lies the true problem of medicine in America. We have the worst possible healthcare system. It is a privately run industry without any real competition. Almost anything would be better - either public healthcare or real competition. Instead, what we practice in America is an exercise in insanity played out on sick and injured.

I agree. When it comes to your or your family's health you will not go with "cheap" even if it is the same level or better service/outcome. This is why the entire system needs to first create a nice feedback loop. Right now there are no metrics on how well certain hospitals are doing that can drive patient selection.

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.

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

#165

Post by king_jester »

bpm140 wrote: post #134
rayiner wrote: post #102

Earlier quoted context omitted.

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 t…

> Ralph Lauren jeans has plenty of competition and the customer is reasonably well informed

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.

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

#166

Post by aestra »

jes wrote: post #72
gnoway wrote: post #59

Earlier quoted context omitted.

Well presumably you're not suffering from an ailment that requires immediate application of TV, Angry Birds or a 2x4 in those cases.

Of the healthcare that is delivered, most is non-emergent.

What if your primary refers you do doctor X for condition Y?

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

#167

Post by aestra »

iyulaev wrote: post #82
zdean wrote: post #56

Earlier quoted context omitted.

Well, I think it would have to start somewhere. I'd be happy to be able to comparison shop for routine, non-emergency stuff...let's say dentists to start off with. I have a feeling that once you start chipping away at it, the outlying examples would get taken care of as well. 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 ou…

I think people already cross-shop dentists. When I had a root canal done I inquired at two places. And I'm not even very sensitive to it since I have dental insurance. Good luck with the same at hospitals though...

I would be nervous to do that. I trust my dentist, I know he does a good job, and is sensitive to my comfort, that's why I go there. I've been to a few terrible dentists before, and I've had to get dental work redone because it didn't last. Dentists seem to be so hit and miss. Doctors can be the same way, price isn't the only consideration.

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

#168

Post by aestra »

five18pm wrote: post #152
bpm140 wrote: 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…

You are equating higher cost with better quality. There usually is a correlation, but with US healthcare's opaqueness with prices, I wouldn't make that correlation. 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…

Anesthesia during wisdom teeth extraction is another good example. I was given 3 options by the oral surgeon (with prices attached)

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.

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

#169

Post by zdean »

chris_j wrote: post #156
tonylemesmer wrote: post #150

Earlier quoted context omitted.

So many unnecessary arguments crop up on this forum because of selective, incomplete reading of comments and misinterpretation. 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.

What could nikatwork have changed about the original comment in order to make the intended meaning more clear here?

"It seems to me that the parlous semi-free market state of the US healthcare system is in fact a perfect demonstration of the dangers we'd encounter if we moved to a completely free market. Claims that "oh no it's not actually free enough" are merely handwaving"

I think that (or something like it) would have been a much clearer approach.

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

#170

Post by duaneb »

rhizome wrote: post #138
duaneb wrote: post #14

Earlier quoted context omitted.

> 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…

> The only people who hate the idea are the hardcore capitalists

Well, them and voters.

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