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Heart Surgery in India for $1,583 Costs $106,385 in U.S.

bloomberg.com

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Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#181

Post by ctdonath »

enraged_camel wrote: post #172
ctdonath wrote: post #161

Earlier quoted context omitted.

I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades , bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home…

You are succumbing to the common fallacy of associating cost with quality. Last week, my dad (who is a doctor in Turkey) was telling me about a new study that compared the cost of healthcare services in various countries around the world and the satisfaction of patients. He said that the USA ranks close to the bottom of the index, meaning that considering how much American patients pay for healthcare, their level of…

You are succumbing to the common fallacy of disassociating cost from quality.

Yes, a good successful job can be done much cheaper - but, on the whole, the odds of success & quality degrade fast when less is spent. When it is YOUR life on the line, you may very well be willing to pay significantly more for those diminishing returns; they may be diminishing, but they are in fact greater returns. "Healthcare tourism" by Americans includes the ability to identify & access those pockets of excellence; those areas in general may not enjoy such inexpensive quality as the norm, nor have easy access to excellent outliers.

BTW: Americans (I speak as one) are a chronically dissatisfied bunch. Having remarkable access to excellence in all things, we bitch & moan about how it isn't oh so slightly better. Yeah we complain about the cost of healthcare, and at the same time demand the absolute very best, quick to sue the pants off any doctor whose work fails perfection standards by any statistically normal degree when something could have been done better regardless of extreme cost. I suggest caring little about opinion polls where objective statistics are available.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#182

Post by GhotiFish »

ctdonath wrote: post #161
DigitalSea wrote: post #9

The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…

I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades , bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home…

This is exactly what is wrong with health care in a free market.

if you had an operation with a 10% chance of failure for $5000, would you take it?

What if you could spend twice the money and cut your risk down to 5% if you quadrupled the expense? $20000, even I'd take that option for you, as an objective observer.

what if you could cut it down to 4% for $50000? Ok now it's getting a little silly, but it's still your life.

what if you could cut it down to 4.75% for $100000? Don't you deserve the best? I mean this is your LIFE. In anything else this would be a silly investment, but your life? You can't take chances. It's a bizzare choice, but really the only rational one in your situation, you have to survive.

So the thinking goes, we are incapable of negotiating for our own lives. To the point where it blinds us, by choosing that expense you doom the ones who can not afford it.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#183

Post by ArbitraryLimits »

danso wrote: post #129

Can't resist posting this anecdote from Atul Gawande's (best known for his New Yorker medical pieces, such as the one about checklists) book, Better: A Surgeon's Notes on Performance...at the end, he describes spending some time in India as a visiting surgeon to see how innovation was possible in comparatively squalid circumstances. The Nanded hospital he describes below serves 1,400 villages, about 2.3 million peopl…

> In my eight years of surgical training, I had seen only one patient with an ulcer so severe that the stomach’s acid had eroded a hole in the intestine.

vs

> patients arrived almost nightly with the condition

It sounds to me like the limiting factor in innovation was a sufficient supply of patients FOR ONE SURGEON to practice on, in which case working in an underserved area is an advantage.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#184

Post by tenfingers »

jfoster wrote: post #102
tenfingers wrote: post #73

I'd like to point out that the price difference is most likely to do with the marked conditions of the health care in general, and has nothing to do with the quality of the operation itself. There is a big problem with health care in most countries that I've been living into for extended periods of time (France, Italy and to a lesser extent Germany). Anything sorrounding "medical" and/or "health care" has a 10x-100x…

Are you sure you're looking at the whole picture? I imagine liability, lawyers, and a much greater interaction with customers will be driving up costs very substantially when selling widgets as medical devices.

Absolutely, but unfortunately all of this only aggravates the problem.

For instance, we needed lawyers and the "study" just to be able to sell the machine at all. But then again, lawyers and the testing itself contributed absolutely nothing really, while being incredibly expensive (both in terms of money, and time). Yes, medical devices need to be tested, but all the testing/layers and related processes only inflate the cost without actually contributing to the product.

The problem is that the process/testing/lawyers for a "medical" device are essentially the same as the testing you would do for something non-medical but that has regulated safety features (such as a children toy at least in EU), yet the "medical" testing is simply more expensive.

We can speak about the rubber in those "Thera Bands" strips. We used bands made for children (which, by definition in EU should be toxic-free and bla bla), and we found absolutely no difference compared to TheraBand (even material wise). Sure, TheraBand had to pay for "testing" indeed, which again contributed nothing to the real product, inflated the cost, and still doesn't justify the 20x price inflation for a piece of elastic rubber.

But still, that's not really it.

By working closely with hospitals, I also know several people in the loop. I had second-hand knowledge (from people that I consider reliable) that offers and prices from big MRI machines from Siemens and similar companies are rigged. And that happens because there's very little competition and no real market (only hospitals will buy such machines).

When all the market is inflated, you can justify high prices for almost every product in it. And that's exactly what's happening.

Plus people need medical assistance, which means that in emergency situations will simply pay for it at any price.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#185

Post by codex »

Given that surgery costs are dominated by labor costs (surgeon plus support staff) and labor costs 20x more in the US than in India (see: http://www.economicpopulist.org/content/china-and-india-real...) is it any wonder that surgery is 10x more expensive in the US? If the only cost were labor it would be 20x!

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#186

Post by mikeash »

acchow wrote: post #56
kamaal wrote: post #42

Earlier quoted context omitted.

>>You don't see this kind of innovation in the American health system because it has been engineered with greed in mind right from the start. As an Indian, I can tell you people here think the same about our health care system. The Doctor in discussion here, Dr Devi Shetty is a sort of a local hero here in Bangalore. And who knows in some years he might as well be a national hero. Its basically because he seems to br…

> You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. I find the vast majority of people are tripped up by currency conversion, but I'm surprised to find this on HN. In Japan $1 = 100 yen, but certainly I don't feel I have 100x in buying power. A bowl of ramen will cost me $8 in SF; an equivalent bowl will cost me 800 JPY in tokyo. L…

It's like measuring your penis in millimeters instead of inches to make it longer.

Zimbabwe is printing trillion-dollar bills, so everybody there must be rich....

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#187

Post by ctdonath »

GhotiFish wrote: post #182
ctdonath wrote: post #161

Earlier quoted context omitted.

I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades , bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home…

This is exactly what is wrong with health care in a free market. if you had an operation with a 10% chance of failure for $5000, would you take it? What if you could spend twice the money and cut your risk down to 5% if you quadrupled the expense? $20000, even I'd take that option for you, as an objective observer. what if you could cut it down to 4% for $50000? Ok now it's getting a little silly, but it's still your…

This is exactly how economic reality works.

Yes, your very life is subject to the costs of diminishing returns. We can't guarantee everyone the very best because it costs too much, and we can't force people to spend less on their life than they can afford and choose to spend because it's not yours to distribute. Tough choices aren't easy.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#188

Post by acchow »

stonemetal wrote: post #145
acchow wrote: post #56

Earlier quoted context omitted.

> You just feel its cheaper as $1 = 60 rupees. There you get a straight 60x value of your money. That is what it is at the end of the day. I find the vast majority of people are tripped up by currency conversion, but I'm surprised to find this on HN. In Japan $1 = 100 yen, but certainly I don't feel I have 100x in buying power. A bowl of ramen will cost me $8 in SF; an equivalent bowl will cost me 800 JPY in tokyo. L…

In Japan $1 = 100 yen Is the Yen equivalent to the dollar though?(are there fractional yen cents and that kind of thing) I guess since the exchange rate has been around that for as long as I have been alive, I have always thought of it as 1 Yen = 1 penny.

> In Japan $1 = 100 yen Is the Yen equivalent to the dollar though?(are there fractional yen cents and that kind of thing)

Why is this relevant?

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#189

Post by splintercell »

DigitalSea wrote: post #9

The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…

>> You don't see this kind of innovation in the American health system because it has been engineered with greed in mind right from the start.

This is nothing but circlejerking. Sure the poor starving people of India are less greedy minded than rich Americans who could afford to be charitable.

The reason why Indian healthcare system has more innovation than American healthcare system is precisely because of the opposite. The latter is more greedy than former and it is allowed to go in the right direction.

Its easy for you to think that a product which is charging $40 per bottle profit on a $10 operating cost would make more profit than competitor's product which charges $5 profit the same bottle, but what you fail to understand that the latter will have more sales and therefore will be able to make more profit. This means people have an incentive to reduce their per item/action profit in order to increase their overall profits.

If American healthcare market was allowed to be more free, you'd see lower prices and WAY more profits for healthcare companies.

Re: Heart Surgery in India for $1,583 Costs $106,385 in U.S.

#190

Post by sliverstorm »

scarmig wrote: post #166
ctdonath wrote: post #159

Earlier quoted context omitted.

The key: His department was able to obtain some older laparoscopic equipment inexpensively. Thanks to high-cost health care systems elsewhere spending enormous sums on the latest & best equipment on a regular basis, older equipment capable of facilitating very good (albeit not best possible) results becomes inexpensive. In all the sneering at the high cost of healthcare in some areas, the consequential benefits to ot…

Is your claim that the existence of excellent high-cost treatment options drive down the price of moderate good ones in the present, or that the moderate-cost good ones were at one point paid for by being the excellent high-cost ones? The two claims have very different policy implications. Overall, though, we should be skeptical of device manufacturers' claims that dumping more money into expensive equipment leads to…

I think his claim is both those things. The R&D of the goods was paid for when they were originally sold as high-cost excellent equipment. Now, the existence of even better high-cost treatment options drives down the price of the older originally-high-cost equipment.
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