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

#71

Post by anateus » Sun, Mar 04, 2012, 8:08 AM UTC

droithomme wrote: post #18

The US has inexpensive MRIs as well. This nationwide chain provides MRIs as low as $335 depending on the state. http://a2zimaging.com/ No insurance accepted, no payment plans. Those cost money. Just charges the cost.

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 decide you drive too much and not cover this months' gas--you can bet prices would go sky high.

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

#72

Post by davidhollander » Sun, Mar 04, 2012, 8:44 AM UTC

Cadsby wrote: post #49

yummyfajitas wrote: post #11

Earlier quoted context omitted.

Most medical procedures are not emergent. It's hard to shop around for emergency care, but shopping around for everything else is pretty straightforward. We have strong experimental evidence that when people are not insulated from price, they shop around and consume less medicine with no measurable effect on their health. http://www.rand.org/health/projects/hie.html

I agree that much of the general public is insulated from price, however a few personal observations: (Note: I worked for 8 years for a state insurance company and my wife has been a nurse practitioner for 12 years) People don't "shop" for healthcare the same way they shop for televisions or other consumer products. In fact the overwhelming majority tend not to all. Either someone like me at their insurance company p…

> so they have little to no basis for making an informed decision about their care or provider

The problem with not allowing individual choice in regards to health decisions is illustrated succinctly by the War on Drugs.

Additionally, even if we rigorously proved that local decision actors in a market operate upon highly imperfect knowledge when making decisions, it would not constitute a proof that a global decision actor with access to enlightened knowledge would be able to make decisions for them more efficiently or justly by employing a non-market based algorithm.

> If a child or loved one is involved you're even less likely to start thinking about dollars over medicine

Why is medicine different from food, water, and shelter? Aren't those even more important survival needs we are forced to make tradeoffs regarding every day?

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

#73

Post by danmaz74 » Sun, Mar 04, 2012, 8:45 AM UTC

yummyfajitas wrote: post #50

Vivtek wrote: post #35

Earlier quoted context omitted.

I've heard this before. Do you think that Germans or the French end users care about the price? No - they're insured far better than any American without a (D) or (R) after their name. They just _go to the doctor when they're sick_. Period.

So France and Germany have some non-price rationing mechanism. Whatever mechanism they have, it causes them to half less than half as many MRI's (per capita) than the US. http://www.oecd-ilibrary.org/docserver/download/fulltext/811...

Just how many of those MRIs in the US are done without insurance or medicare - ie, are subjected to price rationing mechanisms?

Moreover, in a system like the US health care the "average" isn't very meaningful, because if you and I have a sore knee, and you get 2 MRIs per year, and I get none, well...

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

#74

Post by cpeterso » Sun, Mar 04, 2012, 8:46 AM UTC

Not only do Americans spend more per-capita on health care than Canadians, the American government spends more per-capita on health care than the Canadian government. And yet Americans still need private medical insurance. And depending on how you count, more than 60% of American bankruptcies are for unpaid medical bills and about 78% of those people had medical insurance.

https://en.wikipedia.org/wiki/Comparison_of_the_health_care_...

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

#75

Post by danmaz74 » Sun, Mar 04, 2012, 8:53 AM UTC

anateus wrote: post #71

droithomme wrote: post #18

The US has inexpensive MRIs as well. This nationwide chain provides MRIs as low as $335 depending on the state. http://a2zimaging.com/ No insurance accepted, no payment plans. Those cost money. Just charges the cost.

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 my insurance. Then I discovered that particular problem wasn't covered, and well - the prices magically came down to 70€ "You know sir, with insurances we have all those additional costs...".

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

#76

Post by brg » Sun, Mar 04, 2012, 9:00 AM UTC

waitwhat wrote: post #60

jandrewrogers wrote: post #53

Earlier quoted context omitted.

A fact I find distressing is that the poster is largely correct. Somewhere around 70% of biomedical R&D is done in the US, the utter dominance of the US in this market is not controversial. Most of the rest is done in Asia. The biomedical R&D done in Europe is rapidly approaching a rounding error. I, for one, do not like the fact that the entire world is dependent on the biomedical R&D of US companies. Yet that is th…

the entire world is dependent on the biomedical R&D of US companies Inasmuch as it is possible for companies of this size to be from any one particularly country, large American pharmaceutical companies spent $27bn on R&D in 2009, while European ones spent €28.5bn (i.e. 40% more at today's exchange rate.) source: http://en.wikipedia.org/wiki/List_of_pharmaceutical_companie...

That list does not show where the money is being spent by each organization. Instead it only maps the expenditure to the lcoation of a corporations headquarters.

Specifically, consider Bayer. This is listed as a German pharmaceutical company. Bayer reports to have 37,000 employees, however 16,000 of thema are in the USA. (http://www.bayerpharma.com/en/company/index.php, http://www.bayer.com/en/north-america.aspx).

Better statistics are provided elsewhere in wiki, for instance US R&D expenditure dwarfs that of any other country. It is also about 33% higher than that of the combined total of EU countries.

http://en.wikipedia.org/wiki/List_of_countries_by_research_a...

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

#77

Post by iwwr » Sun, Mar 04, 2012, 9:06 AM UTC

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.

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

#78

Post by waitwhat » Sun, Mar 04, 2012, 9:27 AM UTC

brg wrote: post #76

waitwhat wrote: post #60

Earlier quoted context omitted.

the entire world is dependent on the biomedical R&D of US companies Inasmuch as it is possible for companies of this size to be from any one particularly country, large American pharmaceutical companies spent $27bn on R&D in 2009, while European ones spent €28.5bn (i.e. 40% more at today's exchange rate.) source: http://en.wikipedia.org/wiki/List_of_pharmaceutical_companie...

That list does not show where the money is being spent by each organization. Instead it only maps the expenditure to the lcoation of a corporations headquarters. Specifically, consider Bayer. This is listed as a German pharmaceutical company. Bayer reports to have 37,000 employees, however 16,000 of thema are in the USA. ( http://www.bayerpharma.com/en/company/index.php , http://www.bayer.com/en/north-america.aspx ).…

That list does not show where the money is being spent by each organization.

This is irrelevant to the claim I was debunking.

True, the great grand-parent post appears to be conflating where the research was done with the nationality of the company funding the research, and I admit that I only responded to one half of the argument, but that was purely because it was the easiest to fact-check. That doesn't make the other half of the argument true.

Specifically, consider Bayer. This is listed as a German pharmaceutical company.

"American" pharmaceutical companies also have employees in Europe, Asia, and elsewhere.

Better statistics are provided elsewhere in wiki, for instance US R&D expenditure dwarfs that of any other country.

Including, say, military and aerospace R&D with healthcare R&D to try and make a point about just healthcare is clearly ridiculous.

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

#79

Post by rdl » Sun, Mar 04, 2012, 9:38 AM UTC

veidr wrote: post #61

rdl wrote: post #7

Earlier quoted context omitted.

MRI specifically is overused and kind of crappy in Japan. In the rest of the world, the standard is for a 1-3T MR study; in Japan, you get a lot of 0.5 and even lower (0.2T! wtf) MR studies. They're used for a lot of health screenings, whereas in the rest of the world they're more often used for actual problems.

I call bullshit on your first point--that MRIs are "overused" in Japan. MRIs aren't something that can really be overused. Unlike CT scans, or pretty much any non-MRI method of imaging the inside of the body, they don't harm the patient. Even though you are right that many of the MRI machines in Japan are lower-resolution cheaper models, that is largely because there are way more MRI machines here, and they are used…

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 unnecessary surgery are high.

A needs-based study based on having MS, sure, but just getting an MRI as part of a routine checkup, probably not.

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

#80

Post by yaix » Sun, Mar 04, 2012, 10:12 AM 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…

> High health care spending is yet another way the US subsidizes other countries.

Look at the US's trade deficit and dollar devaluations of the past 50 years to see who is subsidizing who. But that's beside the point.

Look at it less nationalistic and rather as corporations vs. consumers. American consumers are "subsidizing" large corporations in an oligopolic market.