Nope. To have healthy competition, would that not require multiple options to the consumer?
So are you suggesting investing capital to increase capacities to , say, 135% of expected usage? That’s wasteful. Bad policy. A plan to reduce the efficiency hardly seems likely to improve the economics.
Added some edits. No, just need to force prices where there is no chance of competition. Not exactly “capitalism” though. 
So you believe investing capital in projects with substandard returns is okay? That is not capitalism mate.
I’m just going over the problems.
Fair enough. Then let’s look at the whole transparency solution for a bit.
How will it work in situations where the providers “discover” an otherwise unexpected problem during a procedure? Like Say they found cancer. Do they ignore it because it’s not in the original quote?
Or do we put in guardrails like an auto mechanic or plumber? They end up with free or low cost estimates. Bring in the car and get an estimate. It happens in many services. General contractors on homes have it happen all the time. The original service gets modified after additional info becomes available.
Health issues are tricky. There is a natural inclination to fix it, whatever the cost. Just human nature. I just don’t see transparency as a solution. It would be great,but how does that actually work?
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anecdote on price transparency (lack of really) in WSJ today (or was it yesterday). Companies changing PBM when the PBM would not share what kind of rebates it got from manufacturers.
transparency is a step towards having the info to make informed choices
How does one consumer get the first provider to break the mold and actually do that? He/she can’t. It takes a concerted effort by a large number of people working together. No point in building an organization from scratch when we already have a government.
Idea: we can boycott the health system!!
Theoretically, a provider will want advertise that they have lower prices, same as we expect from Walmart. Alternatively, a third-party will collect prices, similar to Amazon.
I suppose I should add, my health insurer has been trying this for years. No idea how well it’s going though.
The fact that nobody has tried it so far indicates that there must be something other than normal market forces at work.
Healthcare isn’t like most goods. I don’t think price incentives work quite the same as they do with clothes or tvs or whatever.
I think incentives might work for some people and send other people running elsewhere.
Yes, we already have medical tourism happening, so I guess there is a market for cut-rate healthcare.
Value Based Healthcare is trying to solve for this. It’s a long, long row to hoe. And folks like pharma fight it hard.
I agree with this. For things like primary care, or imaging, those can be shopped. But sooooo much money is in things like single source (brand name, patented) drugs. Free markets work well when the consumer is informed, I don’t think the average person is really equipped to read through manuscripts with survival curves and GLMs and figure it out.
Ditto for many procedures. Healthcare is complicated. So I think things like high deductible plans help but aren’t controlling the bulk of total cost of care.
I think what often happens at the end of life is really, really low-value care. I worked in oncology for seven years and we looked at this. Hospice is probably the best answer we have - I guess palliative care is the better term.
We looked at thousands of deceased pts. For those not in hospice at death, the most likely outcome was death in the ICU. And if you look at what pts say they want (and it’s been done, blanking on the name but he was at Johns Hopkins when I met him) they don’t want to die in the ICU on a vent. This is bad for pts. It’s bad for their families. And it’s expensive. We found back in 2018 that pts on hospice cost $15k less, and we recently did the same analysis for my PCP group and got about the same number.
So with good palliative care and advance care planning we get better outcomes and lower cost. That’s value.
Capitalism requires being able to say no to something. It works well for elective health procedures, where things like Lasik costs are well contained, and it doesn’t work well for insulin prices, where going without isn’t really a viable option. And it doesn’t work well when the number of competitors in a market is artificially restricted.
So many families, or maybe one or two really vocal members, will drive the conversation toward extending life at any cost, but in most cases everyone, even the vocal ones, would be better off with a sooner, more dignified end.
True. Most terminal pts don’t want Herculean efforts. I’ll see if maybe I can track down the data. Maybe Thomas Smith? I can’t recall who showed me all of this data.
Medicare’s admin costs are low for FFS benes. Any other payer, not really close.