Why Medical Bills are Killing Us, by Steven Brill - Page 16

On February 25 2013 09:19 Kyrao wrote:


Good point. In this case I am referring to having things like a CT scanner, MRI, Angio equipment, Nuclear medicine, and other expensive, non-mobile machinery all in one general location. Most doctor's offices refer patients to the hospital when he/she needs one of these tests done, rather than bearing the expense on a piece of equipment that will take far too long to pay off with his/her expected usage to be feasible. This is a powerful way to reduce medical expenses for a regional population, so while you might be able to fragment this kind of equipment between a network of doctors' offices, it would be far more ideal to have a central hospital to house these (which is also especially important in emergency medicine). Also, drugs will always be a separate case because of their mobility (you can bring them to the patient rather than the other way around). The real barrier to reducing drug prices outside of a hospital (where it is heavily marked up for some god forsaken reason) seems to be patent rights, which at its core is necessary for a pharma company's R&D to pay off. I'm not saying there couldn't be better ways of rewarding/regulating patents, but that would be a totally different discussion that I feel completely noobish trying to even talk about.

On February 25 2013 10:44 sam!zdat wrote:
Jonny, how can you possibly say that something is so complex that it can't be understood by a consumer, and then suggest that a market be deregulated, all in the same post?

On February 25 2013 10:51 JonnyBNoHo wrote:

I don't see those aspects as being mutually exclusive. Putting a loaf of bread on the store shelf is extremely complex too (economies of scale to some processes, huge time lags between supply and demand, etc.) but it doesn't mean that I need the government to carefully regulate every step of the process in order to get a fair deal on bread.

On February 25 2013 10:48 Stratos_speAr wrote:


There is no competition to be had in the world of healthcare. The vast, vast majority of patients are involuntary consumers and are not in a position to choose one hospital over another depending on price.

On February 25 2013 10:55 Arevall wrote:


Albeit the cycle for making bread can be a complex one with running the company and small steps, it is nowhere as complex as medical supplies or medical care.

The bread buyer isn't in the same position as a patient either. If he feels he don't know if the price is high or low for the bread he is getting, he can just go buy something else to eat.

On February 25 2013 10:59 JonnyBNoHo wrote:

OK, building skyscrapers is pretty complex - let's use that comparison.

The healthcare consumer can go to a different provider. So the analogy holds on the second point.

Edit: I wasn't just referring to the complexity of baking a loaf of bread. I'm talking about the whole supply chain. I could easily throw smoke in your face regarding the complexity of the push-pull boundary, stochastic demand and the necessity of a high service level to justify a higher than necessary price. But whatever, building a skyscraper should be complex enough.

On February 25 2013 10:51 JonnyBNoHo wrote:

I don't see those aspects as being mutually exclusive. Putting a loaf of bread on the store shelf is extremely complex too (economies of scale to some processes, huge time lags between supply and demand, etc.) but it doesn't mean that I need the government to carefully regulate every step of the process in order to get a fair deal on bread.

On February 25 2013 11:39 Defacer wrote:


Building a multi-level building, or skyscraper, or even a large house is immensely complex and extremely expensive for a property owner or developer. For anything with a construction value over a million, you need to hire a project manager, construction management team and architecture firm, who in turn hire engineering consultants to design and manage the implementation of mechanical and electrical services.

It can take two years just to hire all these people, finalize a design, and get the necessary permits to build it.

Are you saying that people should spend hundreds upon hundreds of hours requesting and reviewing quotes, contracting specialists from different healthcare providers, sourcing their own drugs and equipment, securing their own permits and licenses to treat themselves etc, etc?

I'm sure if I did that I could save money on my hypothetical cancer treatment ... although just managing my own treatment would likely be a 40 to 50 hour a week job, which would be kind of hard to do when you literally have lie in bed all day and shit in a pan.

TLDR; why are you comparing health care to building a skyscraper, exactly? If you're point is that shopping for healthcare in a free market would be a nightmare, than you're right.

On February 25 2013 09:17 Enki wrote:

I'm sure everyone is all for eating healthy, and having the actual food producers stop putting so much shit into the foot supply. A Healthy diet can only take you so far. If you get into bad car accident it doesn't matter how much fruit you eat...most likely you need hospital care and surgery, both of which can destroy your financial well-being for years. Not to mention cancer does not discriminate and has struck down perfectly healthy people.

I think it is a good start though. People should be more educated about proper food choices, but part of the responsibility has to go to the actually producers of the food as they are ultimately in control of what goes into it. Also, people would love to eat healthier and organic and all that shit but the fact is that it's more expensive and a lot of families can't afford it in this economy, especially with food prices to get even higher.

On February 25 2013 11:48 Tarot wrote:

Curious how you think the market should be deregulated.

Because if I was a medical company, and I know that the Feds are completely out of my hair, I'm just going to straight up dump addictive substances into my drugs. I hear from the tobacco industry that addiction is good for customer loyalty.

On February 25 2013 12:02 JonnyBNoHo wrote:

Deregulated means allowing new entrants to compete on service and price. Deregulated doesn't mean getting rid of health and safety regulations.

Ex. Airlines were deregulated. Safety is still regulated by the FAA.

On February 25 2013 12:06 Tarot wrote:

Honest question, so what specific regulations are stopping new entrants from being competitive on price?

On February 25 2013 12:16 Nyxisto wrote:
i really don't understand why the fear of regulation is so huge. it may be an american thing (and no i'm not trying to make an anti-american post or something like that, it's just that most of the posts that share the kind of tone i want to talk about come from american posters) but many posts seem to share the view, that privately run businesses are the heaven of competition and efficiency, and that companies owned by state are run bei lazy monkeys who don't get anything done.

I find it kinda odd that people are still advocating a deregulated market in the healthcare sector. There isn't really any good argument in this thread even after 16 pages , which explains why people who have an accident and need to get treatment fast and are forced to visit the nearest hospital and can't choose between alternatives is not a problem in a free market. Instead people advocating deregulation simply switch to other topics.
Its not like every patient on this planet is treated for cancer, in fact most people who may need medical help may either have had an accident, and in that case you can't choose where to go, or they may have something that requires such simple treatment that driving 60 miles to treat it may be more expensive than just going to the nearest hospital/clinic.

And coming back to state owned/regulated businesses, they're actually doing pretty well. If we for example take the police, or public transport companies, yes they may all be a little bit slow and have some of the typical problems that are associated with state-run organisations, but in fact most of them work pretty reasonably.
It's not like our trains here are all three ours late and crashing into each other just because the "Deutsche-Bahn" is a public corporation.

On February 25 2013 12:47 Gonff wrote:

I completely agree with this post.

As a rhetorical question, why don't doctors themselves take more accountability on the subject of skyrocketing medical costs for their patients? It's not like they have no idea that the people they are treating will suffer tragic consequences from debt. All doctors swear oaths to do no harm. Can an argument be made that doctors do in fact harm their patients when they prescribe those patients treatments they know will cause permanent social/economic harm? Or how about the potential harm those patients may suffer when they decline to seek future treatment because they're still paying for the last drug?

Much like the doctors in the Time article who stood up to the cancer drug company for overcharging and caused it to cut prices by 50% (down to the level of other comparable drugs with comparable effectiveness), maybe there is potential for doctors to make a big difference here? I honestly don't know how I come down on this, but the one thing that I do know is that it seems odd that we ignore the possibility that doctors could maybe make a difference if they took accountability for the cost of the treatments they prescribe.

Edit: I'm not proposing that doctors just decline to treat patients overall if they know those patients are poor. I'm just offering the idea that maybe a visit to the doctor's office should involve a frank discussion that considers the patient's overall economic situation and tries to take that into account when forming a treatment plan (perhaps cutting out some surplus diagnostics or something).

On February 25 2013 13:03 Stratos_speAr wrote:


The medical industry is actually very averse to competition. As an involuntary consumer, you don't have the luxury of taking the time to evaluate and decide what service you want when you need to call an ambulance or run to the emergency room. This is why there is one number to call for emergencies.

Think of a situation where there were two competing hospitals with competing emergency services in the area. For this to work, there would need to be A) a system for individuals calling for an ambulance to pick a hospital to go to while under the duress of the situation, or B) different phone numbers for them to call so they can choose their hospital by virtue of who they call. Both of these are incredibly impractical, and this is why it is set up so that 9-1-1 just gets you an ambulance that goes to a particular hospital. If it weren't set up this way, then competition would be snuffed out by the ambulance service that is lucky enough to be on the receiving end of 9-1-1 calls.

Furthermore, not all hospitals are equal. Hospitals are set up in a fashion so that their specialties are utilized. If competition were to ensue, then the level 1 trauma centers in a metro area would run all of the other hospitals out of the out-patient business necessary to keep them afloat. This is a similar problem to a privatized school voucher system; you'd force many hospitals out of business, leaving many people in less urban areas with long travel times to get to a hospital.

There is literally nothing about the medical industry that is in favor of privatized, competitive healthcare. You'd end up with some hospitals monopolizing emergency healthcare and others monopolizing everyday out-patient healthcare. Both of these would, no doubt, be necessary for a hospital to survive on a competitive business model. Competitive healthcare is completely illogical and the socialized health systems in every other developed nation that put ours to shame shows us exactly this.