[ExI] USA Health Costs

Stathis Papaioannou stathisp at gmail.com
Mon Jun 8 03:13:49 UTC 2009

2009/6/7 painlord2k at libero.it <painlord2k at libero.it>:

> True, to a point.
> Without a real market, it is impossible to develop real alternative to the
> current situation.
> For example, it is not possible to have comparative quotations on the
> value/cost of some procedures, like happen with the car market.
> I want know the market value of a car? a look on-line or I buy a magazine
> about cars. Why I can not know how much is the price/cost of a surgical
> procedure?

What stops you doing this? It's only if the insurance (public or
private) pays 100% that the patient would not be interested in the
cost, although the insurer would be.

>> And
>> even if the patient does his own research, an environment where drug
>> companies and other vendors of medical products or services can
>> advertise freely will result in a bias towards unnecessary treatment.
> Better a bias towards unnecessary treatments than a bias towards not enough
> treatments. Then, in a free market, this become a client decision, not a
> medical decision. The main point is to make possible for the buyers to know
> what is buying and how much is the cost of it.

I don't think you can make the general statement that a bias towards
unnecessary treatment is better. As a doctor, if you think a treatment
will do more good than harm, you recommend it; if you think it will do
more harm than good, you recommend against it; and if you think it is
likely to be neutral in its effects or don't know, you also recommend
against it.

Absent ethical considerations, an insurer will be motivated to reject
payment for treatments that are necessary, while a private doctor will
be motivated to recommend such treatments. Perhaps between them the
right balance will be reached.

>> Look at how much money is spent on "alternative" therapies with no
>> scientific evidence in their favour whatsoever, and extrapolate this
>> to therapies that are not completely inert, but which lack evidence to
>> show that they are helpful in a particular situation.
> Well, I call this "extended experimentation". If it is done with the
> informed agreement of the patient, there is nothing wrong. Main point is to
> make sure the data about the treatment is recorded and used to gauge his
> value.
>> You might say
>> that it's OK if people are willing to pay,
> So I do.
>> but apart from the fact
>> that these therapies may do more harm than good,
> "May" is the word, we are not sure.
> Until the patient is correctly informed, it is his choice.

In general, neither public nor private insurers will pay for
unnecessary or harmful treatments, but a patient is free to pay cash
if he can find a willing provider. This is fair enough if the patient
is informed of the risks.

>> it does add
>> needlessly to the total cost of health care, and takes resources away
>> from where they might yield greater benefit.
> It is not your or my or anyone right to choose how to use someone else
> money. It is the right of the people owning the money to choose how use it.
> Who are you or someone else to rule how they must use their wealth? Are you
> morally better than them?

But if it is tax money then we have a responsibility to use it
appropriately. Even private hospitals in most places are regulated so
that patients can be assured of a certain minimum standard.

Stathis Papaioannou

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