I have the opposite viewpoint, and I lean heavily progressive in most of my views.

Healthcare in the United States isn't a market, and that is why it is so terrible. For instance, there is no reasonable ability to compare prices of services. Prices are entirely hidden. Then there is the "with insurance" price vs cash prices.

Healthcare doesn't function as a market, to our detriment.

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Sparkle-san 2 hours ago | parent | next [-]

Healthcare doesn't function as a market because the nature of it is largely at odds with the principals of an efficient marketplace and perfect competition. Not to mention the tens of billions of dollars being pocketed by middlemen every year.

	▲	beej71 an hour ago \| parent [-]
		In some places, free market healthcare is great. Dermatologists, dentists, chiropractors, things like that. And part of the reason it's great is because you get to shop around and people fight for your business. In other areas, like heart attacks and strokes, you do not get to shop around. And you pay whatever they say you will pay. When those are the circumstances, there is simply no free market. And since no one is competing for your business with lower prices in that case, you do not get to see lower prices. They charge whatever they can maximally wring out of you.

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venturecruelty 2 hours ago | parent | prev | next [-]

Sorry, I'm not going to Google "cheap MRIs near me" when I'm bleeding out on the floor having an emergency. Healthcare is not expensive because you can't see how much a doctor visit costs, it's expensive because that's how a lot of people make a lot of money, and they get very upset when that is threatened.

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celeritascelery 2 hours ago | parent [-]

Most medical care is not an immediate emergency. If I could compare MRI prices and it would impact how much I pay (either as an insurance copay or out of pocket) I would absolutely do that. But I have no opportunity to do that so there is not price feedback like there is in a market.

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Sparkle-san 2 hours ago | parent | next [-]

Even if it's not an emergency, many medical events come with a lot of unknowns. Like having a baby. No way to say how long labor might be, if there will be complications, how long you'll need to stay afterwards. MRIs are actually pretty easy to shop around for and MRIs don't make up a huge part of healthcare.

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venturecruelty an hour ago | parent | prev [-]

Sorry, this is simply not true. Every 1-3 years, I get a simple diagnostic procedure to make sure I don't get cancer. Without it, I'm at a very real risk of developing cancer that would quickly kill me.

There is no universe in which it doesn't cost around $10,000. None. It is simply impossible for me to get out of paying that. My options are:

1. Use insurance, and hopefully it's covered.

2. Pay out of pocket.

3. Skip it and hope I don't die.

That's it, those are my options. I can't "shop around" for this, and I shouldn't have to. This is basic medical care available to everyone in a developed nation. Ours is the only one for whom this is apparently an intractable problem, and I am, frankly, tired of being gaslit about it.

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phil21 23 minutes ago | parent | next [-]

Many of those “simple diagnostic procedures” are a tenth of the cost if done outside of insurance out of pocket. MRIs are one of them.

My routine blood work done via my doctor bills something like $1600 to my insurance every other year or so - but it do it on my own outside of the medical system for about $180 every six months.

No one should have to do this for necessary care - but once you get into things not typically covered by insurance like plastic surgery or LASIK the true costs are generally rather reasonable.

A whole shadow ecosystem for “health hackers” or whatever you might want to call it exists where standard medical stuff is 10% of the cost if paid out of pocket and through alternative prescribers. It’s a small subset of all available medical items, but the difference in true cost is illuminating.

	▲	outside1234 5 minutes ago \| parent [-]
		That's what the parent is saying. This is totally insane and should be just handled for us with a system that is something like what almost every other country has put in place.

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jay_kyburz an hour ago | parent | prev [-]

I wonder if you could pay a few air fairs and have the procedure done overseas and still come out ahead?

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fancy_pantser an hour ago | parent | prev | next [-]

> Prices are entirely hidden

Recent legal changes have made pricing more transparent. In 2020, the federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. This limited the expenses for emergency care when out-of-network and a few other things, but even more exciting is that hospitals and insurers are now required to publish a comprehensive machine-readable file with ALL items and services. They have to provide all negotiated rates and cash prices for the services and include a display of "shoppable" services in a consumer-friendly format. The machine-readable files are impractical to process yourself for comparison shopping (picture: different formats, horribly de-normalized DB dumps), but many sites and APIs have emerged to scrape them and expose interfaces to do so.

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waterTanuki 32 minutes ago | parent | prev [-]

Nor should it strive to be a market. Healthy markets can only exist where demand is elastic. If the choice is between dying to kidney failure or enduring life-crushing medical debt, you bet I'm going to do anything it takes to get that transplant. And therein lies the problem: You *cannot* have healthy markets in healthcare. Period. Demand for healthcare is fully inelastic. Anyone arguing the opposite is either profiting off the status quo or woefully ignorant of economics.

	▲	sershe 18 minutes ago \| parent [-]
		I think this is actually an opposite problem. For kidney failure in particular, you can check the insane amount USG spends on end stage care. The demand for healthcare at the limit exceeds any reasonable supply. Healthcare spending across counties goes up pretty much with disposable income. There are massively expensive interventions that could give someone close to death few extra months. Healthcare has to be rationed. Rationing by market is the least bad kind of we learn anything from history... Too bad healthcare in the US is not a market in any way or form, and in fact the most expensive least DALY efficient interventions (Medicare) are subsidized at the expense of everything else.