Heeeeeeere's Obamacare!

[jimbob]

Oh, I'm not stupid enough to deny that the US has some amazing demonstrations of venality, stupidity and incompetence in their politicians...

Just that the UK can also mange some pretty good ones too.

Rail privatisation was another - the UK's state spending on the railways increased once they were privatised.

The East coast mainline did so badly that it was renationalised, whereupon the cost to the taxpayer fell - so now it is being reprivatised.

 

[Kestrel]

On the order of about 60% of all medical costs are routine and preventive. Another 20% are acute accident-related injuries. Only about 20% of all costs are from chronic and serious conditions... and those account for a relatively few number of services.

20% of the people generate 80% of the costs. 5% of the people generate 50% of the costs. In any given year, about 25% of people won't have any claims at all. It's the tail of the distribution that drives the cost.

For the vast majority of people, it IS for paying for routine visits.

Do you have a reliable source for that breakdown?

 

[Emily's Cat]

Do you have a reliable source for that breakdown?

Milliman Health Cost Guidelines, 2013 edition... But if you want me to post screen pics, you're going to have to pay their licensing fee

 

[sunmaster14]

I know I'm several days behind here... but I'm going to chime in anyway.

This isn't true.

Well, you sure didn't provide any evidence of that below.

First, I think you're conflating the decisions with the services rendered.

I actually meant in terms of the dollar value of the decisions to spend, since that's what is most relevant economically, but if you want to focus on individual decisions, then it is almost certainly higher, since, in a freer market, every currently bundled decision could be unbundled into multiple options. You are making the mistake of thinking in bundled terms. For example, you count the decision to choose a doctor as a single decision, when in fact, each time you choose to engage his services is a separate decision.

Most of the services rendered are routine visits and preventive care. But the decisions involved in those aren't all that big. You don't make a decision about preventive care every time you get your annual screening. You only get involved in the decision-making process for your preventive screening when you're selecting a doctor and determining how frequently you should go. After that, it's just wash, rinse, repeat.

You could say the same thing about getting maintenance on your car. Or having your lawn mowed, or getting groceries each week. Just because many people are on autopilot and don't continually refresh their decisions, that in no way means the free market isn't working. As long as some consumers are engaging in a cost-benefit analysis some of the time, the free market works pretty well, in aggregate. Sure, you may allow your cell phone provider to overcharge you for a while (as I am doing, no doubt), but eventually you'll recognize it and negotiate a better plan or switch providers.

Routine and preventive care services account for approximately 60% to 70% of the total services for a commercial population. It varies by location and by plan design. But generally speaking, that's the portion of actual claims that are represented by services in those categories.

You're making my argument better. I didn't even know it was that high a percentage for things which are obviously analogous to getting maintenance on your car, or your house.

Routine and preventive care are really the only ones that can reasonably be expected to be subject to market forces. Those are the only ones where the average citizen can be expected to have both the time and the knowledge to make an informed decision.

The only ones? What is the evidence for that?

The remainder of the services rendered - the remaining 40% of the services - are NOT routine or preventive on average. They require expert medical guidance that the average consumer shouldn't be expected to have. Or alternatively they are acute situations that do not allow the consumer time in which to make an informed decision. Or both.

First of all, I didn't choose that 98% figure out of my posterior. It was based on the fact that roughly 2% of health care spending is on emergency room care. Yes, I can see that if you're unconscious, or just in terrible pain, you have a hard time doing a proper cost-benefit analysis. Of course, that's why there are financial products such as insurance. People found that it's difficult to negotiate with a funeral home too just after a loved one dies, so products were developed which allowed you to negotiate the purchase of such services in advance.

Second, I still don't see why you think that the vast majority of even the 40% you're talking about is fundamentally different from any other area of the economy. People engage in transactions involving all kinds of products and services in which they have no expertise. Although I used to know quite a bit about cars 20 years ago, I feel like I've completely lost the thread and am quite clueless when it comes to purchasing or repairing one. And yet, somehow I can do a little research on the internet, ask for advice from friends, and get more than one expert opinion. My family has actually had to deal with quite a few serious medical issues over the last fifteen years, and serious cost-benefit decisions had to be made, although the dollar cost was never a serious part of the calculation because of the crazy system we have. I found getting the information (other than actual price) to be far easier for medical issues than for almost any other big consumption decision I've ever had to make. It's always possible (indeed advised) to get a second professional medical opinion for any serious problem. In our case, we sometimes even got a third.

Those services, however, account for more than 40% of the decisions being made. There are far more decisions involved in treating and maintaining a chronic condition than in getting a routine checkup.

Yes, but that says nothing about whether it can or should be subject to market forces. Each day you're living with a chronic illness involves a decision - whether to continue with the current treatment, try another in addition, try another in lieu, or stop treatment altogether. Currently, those decisions involve the various risks and benefits to health, along with the discomfort of each option. I don't see why it shouldn't also involve the actual cost. After all, resources are not unlimited.

I know there are plenty of unthinking people who object and say "you shouldn't make people choose between their health and their money." To which I say, people do it all the time in other areas of the economy. And, in any case, in a world of limited medical resources, invariably the choice is between their health and somebody else's health.

 

[sunmaster14]

On the order of about 60% of all medical costs are routine and preventive. Another 20% are acute accident-related injuries. Only about 20% of all costs are from chronic and serious conditions... and those account for a relatively few number of services.

20% of the people generate 80% of the costs. 5% of the people generate 50% of the costs. In any given year, about 25% of people won't have any claims at all. It's the tail of the distribution that drives the cost.

For the vast majority of people, it IS for paying for routine visits.

I don't see how your numbers can be reconciled. If only 40% of health care costs are non-routine, non-preventative, and 5% of the population incurs 50% of the costs, then that means that, even if those 5% are using 100% of the 40%, they're still consuming 1/6 of all routine and preventative services on top of that. How can that possibly be? Is it the case that 1/20 of the population (in my example, they would be the sickest people too) are using up 3.3x the average in routine, preventative care? Not only are they really sick, but they're hypochondriacs too!

 

[logger]

UK healthcare in crises?

http://www.independent.co.uk/life-s...ting-times-are-worst-in-a-decade-9961509.html

 

[Emily's Cat]

Second, I still don't see why you think that the vast majority of even the 40% you're talking about is fundamentally different from any other area of the economy. People engage in transactions involving all kinds of products and services in which they have no expertise. Although I used to know quite a bit about cars 20 years ago, I feel like I've completely lost the thread and am quite clueless when it comes to purchasing or repairing one. And yet, somehow I can do a little research on the internet, ask for advice from friends, and get more than one expert opinion. My family has actually had to deal with quite a few serious medical issues over the last fifteen years, and serious cost-benefit decisions had to be made, although the dollar cost was never a serious part of the calculation because of the crazy system we have. I found getting the information (other than actual price) to be far easier for medical issues than for almost any other big consumption decision I've ever had to make. It's always possible (indeed advised) to get a second professional medical opinion for any serious problem. In our case, we sometimes even got a third.

Alternative medical opinions are still medical opinions - you're still relying on someone else's expertise. How much internet research do you think you can do to be qualified to determine which of three treatment options is the right one for your uterine fibroid? How much independent study do you think the average consumer can (and should) do to decide whether the doctor suggesting myomectomy is right versus the doctor suggesting arterial embolization is right - especially when they're two completely different doctors in two different specialties? How much consumer education goes in to making sure that a doctor is giving you the right diagnosis in the first place?

I know more about the health care industry than the average bear... and having been through this first hand, it's NOT exactly easy to get information. Cancer is fairly easy to get information on, all things considered. There are dozens other issues that are more complicated, less well known, and less cut-and-dried. Just trying to find good information on what prohpylactic drug I should try for my migraines, given that topamirate didn't work well for me, has been an enormous hassle - it's all anecdotal information from other individuals. And bear in mind that I actually do know how to read and interpret clinical studies and averse reaction stats! But none of that gives me much of a clue for trying to make a decision on my own about which drug I should request when I go in to see my neurologist.

It is infinitely easier to find information about cars than it is about medical conditions. There are orders of magnitudes more medical conditions than there are cars, with many orders of magnitudes many more complicating factors and treatment options than there are categories and options of vehicle.

Yes, there are other complicated fields out there... and those are the fields that we rely on experts for - like legal guidance. How many people do you see doing research so they can defend themselves in court instead of using a lawyer? Or even doing their own research into precedents and prior cases to develop an approach for their own hearing? You know why? Because the average person cannot (and should not) be expected to have the knowledge to act as a consumer of legal information - no more so than they should be expected to act as a consumer of medical information beyond the basics.

 

[Emily's Cat]

I don't see how your numbers can be reconciled. If only 40% of health care costs are non-routine, non-preventative, and 5% of the population incurs 50% of the costs, then that means that, even if those 5% are using 100% of the 40%, they're still consuming 1/6 of all routine and preventative services on top of that. How can that possibly be? Is it the case that 1/20 of the population (in my example, they would be the sickest people too) are using up 3.3x the average in routine, preventative care? Not only are they really sick, but they're hypochondriacs too!

Someone with a chronic condition will go see their primary care doctor about once a month if they're not well controlled. At least quarterly if they're well controlled. It varies by condition, but yes, they use routine services much more frequently.

You might want to nitpick the numbers here. Truth be told, I'm not even trying to break down office visits. I'm looking at the costs associated with Office Visits and Preventive Care, regardless of what the office visit was for. If you really wanted to drill down, you could try really hard to make some determination of whether a visit was for a routine purpose (as well as having to define what a routine purpose is in the first place) or not... but I really don't feel like digging in to the CPT level of the data .

So basically, Office Visits, Preventive Visits, Community Health, and a couple of other basic things are being considered "Routine". ER Visits, and half of the non-preventive labs and screenings, as well as half the IP stays are being considered acute (this jives with prior studies we've done that actually do look at cause of services). The rest is getting lumped into Chronic. Consider there to be a +/- 5% error bound on each of those, for variations in population, geography, and pool health.

 

[xjx388]

Here's a report that supports the idea that healthcare spending is concentrated amongst the sickest.

 

[sunmaster14]

Alternative medical opinions are still medical opinions - you're still relying on someone else's expertise. How much internet research do you think you can do to be qualified to determine which of three treatment options is the right one for your uterine fibroid? How much independent study do you think the average consumer can (and should) do to decide whether the doctor suggesting myomectomy is right versus the doctor suggesting arterial embolization is right - especially when they're two completely different doctors in two different specialties? How much consumer education goes in to making sure that a doctor is giving you the right diagnosis in the first place?

I know more about the health care industry than the average bear... and having been through this first hand, it's NOT exactly easy to get information. Cancer is fairly easy to get information on, all things considered. There are dozens other issues that are more complicated, less well known, and less cut-and-dried. Just trying to find good information on what prohpylactic drug I should try for my migraines, given that topamirate didn't work well for me, has been an enormous hassle - it's all anecdotal information from other individuals. And bear in mind that I actually do know how to read and interpret clinical studies and averse reaction stats! But none of that gives me much of a clue for trying to make a decision on my own about which drug I should request when I go in to see my neurologist.

It is infinitely easier to find information about cars than it is about medical conditions. There are orders of magnitudes more medical conditions than there are cars, with many orders of magnitudes many more complicating factors and treatment options than there are categories and options of vehicle.

Yes, there are other complicated fields out there... and those are the fields that we rely on experts for - like legal guidance. How many people do you see doing research so they can defend themselves in court instead of using a lawyer? Or even doing their own research into precedents and prior cases to develop an approach for their own hearing? You know why? Because the average person cannot (and should not) be expected to have the knowledge to act as a consumer of legal information - no more so than they should be expected to act as a consumer of medical information beyond the basics.

I don't see what this has to do with whether or not people can make rational cost-benefit decisions with regard to healthcare. Where is the market failure? Are you implying that doctors will try to up-sell you on various treatments, and there's no way you can find out if they're cheating you? My vision of the future is that you go to the doctor, and he presents you with a range of options, including the prices for each. If, for some reason, you think he's dishonest (and perhaps a quick perusal of Consumer Reports or Angie's List or WhatsUpDoc.com or DoctorWhat.com will confirm this), then you can get a second opinion.

 

[sunmaster14]

Someone with a chronic condition will go see their primary care doctor about once a month if they're not well controlled. At least quarterly if they're well controlled. It varies by condition, but yes, they use routine services much more frequently.

You might want to nitpick the numbers here. Truth be told, I'm not even trying to break down office visits. I'm looking at the costs associated with Office Visits and Preventive Care, regardless of what the office visit was for. If you really wanted to drill down, you could try really hard to make some determination of whether a visit was for a routine purpose (as well as having to define what a routine purpose is in the first place) or not... but I really don't feel like digging in to the CPT level of the data .

So basically, Office Visits, Preventive Visits, Community Health, and a couple of other basic things are being considered "Routine". ER Visits, and half of the non-preventive labs and screenings, as well as half the IP stays are being considered acute (this jives with prior studies we've done that actually do look at cause of services). The rest is getting lumped into Chronic. Consider there to be a +/- 5% error bound on each of those, for variations in population, geography, and pool health.

None of this is terribly relevant to the point I was making, but I think it's a mistake to lump Office Visits in with routine and preventative care. The bulk of that, in dollar terms, is very likely to be specialist care. I bet even my (mostly useless) physical therapy for a broken arm three years ago would be included under Office Visits, since I actually went to an office. There's no way I would have done that physical therapy if I had to pay the full cost of $100 per session as opposed to a $20 copay. As it was, I cut short the 16 sessions I had been prescribed because I just didn't want to waste the time anymore. Nothing against the therapist. She was very nice, and probably pretty good, but I simply wasn't doing anything I couldn't do at home or at work, by myself.

 

[Emily's Cat]

I don't see what this has to do with whether or not people can make rational cost-benefit decisions with regard to healthcare. Where is the market failure? Are you implying that doctors will try to up-sell you on various treatments, and there's no way you can find out if they're cheating you? My vision of the future is that you go to the doctor, and he presents you with a range of options, including the prices for each. If, for some reason, you think he's dishonest (and perhaps a quick perusal of Consumer Reports or Angie's List or WhatsUpDoc.com or DoctorWhat.com will confirm this), then you can get a second opinion.

It's not a matter of mere pricing consideration, nor is it a matter of cheating. It's a matter of having the knowledge required to make a good informed decision as a consumer.

As a consumer, the choice to buy something isn't based solely on the cost of the product. It's also based on it's utility to you and it's perceived value to you. Then you weigh those elements against budget and price. This is of course severely simplified, but the concept should hold for our purposes.

I'll use my own experience as a platform for this, because I think it will be easier to follow with some specifics. Several years ago, I had a uterine fibroid that was undiagnosed. It was interior, so it wasn't palpable during my regular pelvic exams. I had some symptoms that would have suggested a fibroid, but the symptoms manifested over the course of several years, to several different doctors - I had idiopathic hematuria, I was osteopoenic, and anemic. The hematuria manifested to my PCP in 2007, the oseopoenia was identified by an orthopedist when I had a stress fracture of my tibia in early 2010, and the anemia was diagnosed by my gynecologist in late 2010. Just a month after the anemia was diagnosed, the fibroid hemorrhaged, and I nearly died.

The emergency room doctors stabilized my blood loss, and identified the problem. At that point, it was up to me to go back to my gynecologist and figure out what to do about it. My gynecologist listed three options: hysterectomy, myomectomy, and arertial embolization. She was qualified to do the hysterectomy, and gave me information about that procedure... but the other two procedures were performed by two completely different types of doctors, and she knew little about them other than the very basics.

So I attempted to do research on my own. Of the three, only one (myomectomy) preserved my fertility, but since I didn't plan on having children, that wasn't a large concern for me. Both the myomectomy and the arerial embolization left me open to the possibility that the fibroid could grow back in the future. All three had different rates of complication, different recovery times, and different impacts on my life. Unlike cancer, which has pretty well documented probabilities of survival and recurrence, those stats aren't as easily available for other conditions. Trying to find actual statistics and details for the rates and types of complications for each option was incredibly difficult.

And all of this is before I even begin to consider the difference in cost.

And to add some fun to the mix, I needed to make a decision within about two weeks - well before my next menstrual cycle began, where I would likely hemorrhage again and run the risk of bleeding to death - again.

I managed in part because I did NOT try to do all the research, and because I decided I didn't give a @#$@$ about the cost. I didn't have time to find out all the things I actually wanted to know, and I went into it feeling rushed and uncertain, and not at all informed.

I settled on a myomectomy, mostly because it left me the option of having kids if I changed my mind, and also because the doctor who would perform the surgery was highly recommended - NOT because I was well informed about the choice I was making.

Even once that choice (of sorts) was made, it didn't end there. There were still questions about drugs to take prior to surgery in order to halt my menstrual cycle so I didn't bleed to death, and to try to build up my red blood count so I'd survive surgery. And when that didn't work, there were decisions about blood transfusions. I was no qualified to decide whether or not the drug recommended to me was the right drug to take, or whether it was too expensive. I just took it so I didn't bleed to death. I wasn't in a position to make an informed decision about whether or not I wanted a blood transfusion, or even to consider the risks of a transfusion... because without it I would not survive surgery.

So tell me... how exactly do you believe a "good consumer" should behave in a situation like mine, and what exactly do you think constitutes "well informed" decision? Do you think that "a little research on the internet" is sufficient for me to actually know anything at all about what the right treatment approach is?

Bear in mind that I probably have more knowledge and more resources at my disposal than most average consumers. I at least know how insurance works, and I have several very knowledgeable case managers, nurses, and doctors at my disposal. Most people don't have that luxury, and can't just holler at a trusted coworker for advice.

 

[Emily's Cat]

None of this is terribly relevant to the point I was making, but I think it's a mistake to lump Office Visits in with routine and preventative care. The bulk of that, in dollar terms, is very likely to be specialist care. I bet even my (mostly useless) physical therapy for a broken arm three years ago would be included under Office Visits, since I actually went to an office. There's no way I would have done that physical therapy if I had to pay the full cost of $100 per session as opposed to a $20 copay. As it was, I cut short the 16 sessions I had been prescribed because I just didn't want to waste the time anymore. Nothing against the therapist. She was very nice, and probably pretty good, but I simply wasn't doing anything I couldn't do at home or at work, by myself.

Physical therapy is not under office visits. It includes only professional time for generalists and specialists. It doesn't include any labs, scans, blood draws, or similar - only the time spent in the office.

You can think it's a mistake all you want. But I'm the one sitting here looking at the actual data and the model... and I'm not about to re-engineer the entire thing for this Like I said, consider it a swag and give it a +/-5% range around each. Or ignore it if you feel like you know more about it than I do. Whatever floats your boat.

 

[Trakar]

I'll use my own experience as a platform for this, because I think it will be easier to follow with some specifics. Several years ago, I had a uterine fibroid that was undiagnosed. It was interior, so it wasn't palpable during my regular pelvic exams. I had some symptoms that would have suggested a fibroid, but the symptoms manifested over the course of several years, to several different doctors - I had idiopathic hematuria, I was osteopoenic, and anemic. The hematuria manifested to my PCP in 2007, the oseopoenia was identified by an orthopedist when I had a stress fracture of my tibia in early 2010, and the anemia was diagnosed by my gynecologist in late 2010. Just a month after the anemia was diagnosed, the fibroid hemorrhaged, and I nearly died.

The emergency room doctors stabilized my blood loss, and identified the problem. At that point, it was up to me to go back to my gynecologist and figure out what to do about it. My gynecologist listed three options: hysterectomy, myomectomy, and arertial embolization...

My wife experienced a very similar event a few years back, Luckily, we had good coverage and she got very good care. Once the problem was identified (after she nearly died) the decision was much easier and quickly made, as she was already postmenopausal. It turns out she had probably been suffering many of the side effects of this (a growing fibroid mass which was also pressing on a nerve plexus) for at least a couple of years and was much better after her hysterectomy.

The problem for people without decent insurance is that even detectable problems similar to this can go way past the point where they could be much more easily (cheaply) dealt with simply because they don't go in for annual checkups even when they start noticing that there is something wrong, because it becomes an issue of do I make my car payment or go in for an exam?

 

[sunmaster14]

It's not a matter of mere pricing consideration, nor is it a matter of cheating. It's a matter of having the knowledge required to make a good informed decision as a consumer.

As a consumer, the choice to buy something isn't based solely on the cost of the product. It's also based on it's utility to you and it's perceived value to you. Then you weigh those elements against budget and price. This is of course severely simplified, but the concept should hold for our purposes.

Ok, but uncertainty or imperfect knowledge is not a market failure. You make the best decision you can with the information you have. We do this all the time. At some level, there is uncertainty in every trade we make, or every action we take. Adding in price considerations increases your workload somewhat, but the increase in efficiency and utility for society is well worth it. I've never actually seen anybody make the argument that we need to move away from free markets because adding in price information will overload the consumer (although I have seen companies offer bundled products to attract overloaded consumers with the prospect of having fewer choices to make). Perhaps you're not making that argument though.

I'll use my own experience as a platform for this, because I think it will be easier to follow with some specifics.

<snip>

So tell me... how exactly do you believe a "good consumer" should behave in a situation like mine, and what exactly do you think constitutes "well informed" decision? Do you think that "a little research on the internet" is sufficient for me to actually know anything at all about what the right treatment approach is?

Once again, I don't see what you're gaining by removing the price information. Is it really just a workload issue, or are you implying that somehow the doctor will try to steer you to the more expensive (or even unnecessary) solution, and you don't have enough knowledge to avoid being ripped off?

You seem to have had three options, let's call them A, B, and C, and you agonized over the risks and benefits of each one because there was no clear "best" or "worst" option. I certainly understand that this is very difficult. I've been through this many times myself, although not for my own health. Now suppose you were told that option A, which you were leaning towards, cost $100,000, option B cost $25,000, and option C cost $25,000, but your insurance company was covering the full cost regardless. Would that matter to you? How about if your insurance company, which is footing the bill in total, offered to give you a check for $10,000 if you chose option B or option C, in addition to paying the full cost of treatment. Would that make your decision easier, or harder? If it makes your decision easier, it's a good thing for the insurance company to add this little twist, right? And if it makes your decision harder, you always have the option of refusing to consider the insurance company's offer. Just ignore it, right?

 

[Emily's Cat]

Ok, but uncertainty or imperfect knowledge is not a market failure. You make the best decision you can with the information you have.

All of your post seems to be missing the key point here. Most people can't reasonably be expected to have enough informational that they understand to be able to make an informed decision.

Uncertainty and incomplete information is one thing. Virtually no information, or information of such complexity that you can't reasonably understand or assess it is another matter altogether.

It's like asking a layman to make a decision about what voltage to apply to the electron stream in a supercollider (I don't even know if that makes sense). It's all well and good for you to say "uncertainty" and "imperfect knowledge"... but it's something altogether to expect someone without appropriate training and knowledge to actually make that decision with any degree of competency.

Once again, I don't see what you're gaining by removing the price information. Is it really just a workload issue, or are you implying that somehow the doctor will try to steer you to the more expensive (or even unnecessary) solution, and you don't have enough knowledge to avoid being ripped off?

How do you evaluate the price-benefit trade off when you can't evaluate the benefit and efficacy of the options being offered? If you're not competent to determine which of the options being offered is a higher-quality or more effective option, how do you go about determining which price is acceptable for what you're getting?

 

[sunmaster14]

All of your post seems to be missing the key point here. Most people can't reasonably be expected to have enough informational that they understand to be able to make an informed decision.

Uncertainty and incomplete information is one thing. Virtually no information, or information of such complexity that you can't reasonably understand or assess it is another matter altogether.

It's like asking a layman to make a decision about what voltage to apply to the electron stream in a supercollider (I don't even know if that makes sense). It's all well and good for you to say "uncertainty" and "imperfect knowledge"... but it's something altogether to expect someone without appropriate training and knowledge to actually make that decision with any degree of competency.


How do you evaluate the price-benefit trade off when you can't evaluate the benefit and efficacy of the options being offered? If you're not competent to determine which of the options being offered is a higher-quality or more effective option, how do you go about determining which price is acceptable for what you're getting?

I think it is you who is missing something. We hire experts and consultants to help us diagnose our problems and understand our options. Doctors are no different from any other kinds of expert, from lawyers to auto mechanics. Ideally, a doctor would say "if you choose option A, here is the range of outcomes and the probabilities associated with each. If you choose option B, here is the range of outcomes, etc." You don't have to be a brain surgeon to understand what the potential risks and benefits of brain surgery are. (This is not simply an offhand remark, by the way, but I believe this from personal experience.) Now, I understand that doctors don't do probabilities so well. They're frustratingly math illiterate in general. But they do have experience translating medical jargon into the common tongue, and they can certainly give you a sense of the benefits and risks of different options. For example, if they say "well, if you want to play tennis again, you're really going to have to have that elbow surgery, which is quite expensive, but without the surgery you're not going to be impeded in normal activities." And somebody like me might say "screw it" but somebody like Roger Federer might say "let's go for it."

You seem to be implying that there are medical problems which are so complex that it's impossible even to understand the benefits and the risks. Maybe so (although I haven't heard of any), but in that case, why shouldn't you go with the cheapest option?

 

[Trakar]

I think it is you who is missing something. We hire experts and consultants to help us diagnose our problems and understand our options. Doctors are no different from any other kinds of expert, from lawyers to auto mechanics...

You apparently have very little real world experience interacting with doctors.

Most do not think they are God, but seem to be pretty sure that if God had any questions he would call them up for advice.

 

[Francesca R]

I don't see what you're gaining by removing the price information [about different medical solutions that have uncertain non-monetary benefits and costs] [ . . . ] And if it makes your decision harder, you always have the option of refusing to consider the insurance company's offer. Just ignore it, right?

How do you evaluate the price-benefit trade off when you can't evaluate the benefit and efficacy of the options being offered? If you're not competent to determine which of the options being offered is a higher-quality or more effective option, how do you go about determining which price is acceptable for what you're getting?

Further to this, Sheena Iyengar (Columbia Uni) has a good take on the downside of choice in the domain of medical treatment (not just that):

(page 32 of first link):
In the United States, the paradigm that has dominated bioethics over the past 20 years is based on the principle of patients’ autonomy [ . . . ] In this respect, patients are believed to know their preferred treatment better than anybody else, including the physicians

[ . . . ]

Yet evidence suggests that both physicians and the lay public overestimate the extent to which patients would want to be involved in the decisions related to their treatment. Strull, Lo, and Charles (1984) conducted a survey on patients and physicians and found that 47% of patients preferred that clinicians make the therapeutic decision, 19% wished that they could share the decision with the doctor, and only 3% reported a desire to make the decision themselves.

She argues plausibly that choice reduces social welfare in some cases. (A stylised extreme example of this is from the novel "Sophie's Choice" which is not about medicine, but it illustrates starkly the link between choice and responsibility as causal agent)

Adding price information out of an expectation that this will optimise a market (commoditise it is what some moral scholars would say) could be expected to exacerbate this issue. Paradoxically the option to ignore the extra freedom to choose may not be a panacea.

 

[sunmaster14]

Further to this, Sheena Iyengar (Columbia Uni) has a good take on the downside of choice in the domain of medical treatment (not just that):

She argues plausibly that choice reduces social welfare in some cases. (A stylised extreme example of this is from the novel "Sophie's Choice" which is not about medicine, but it illustrates starkly the link between choice and responsibility as causal agent)

Adding price information out of an expectation that this will optimise a market (commoditise it is what some moral scholars would say) could be expected to exacerbate this issue. Paradoxically the option to ignore the extra freedom to choose may not be a panacea.

Yes, I am aware of this effect, which is purely a psychological one. Unfortunately, human beings aren't "econs" as psychologists call the idealized rational agents that economics assume. But the effect is not restricted to medical decisions. Far from it. Sophie, for example, was not making a medical decision. In fact, one of the problems with Sophie's dilemma was that she was forced to reveal information to her children by making her choice, thus exacerbating the pain and humiliation.

Of course, the way to mitigate (if not entirely eliminate) the paradoxical cognitive discomfort of being given choices/options, or extra information, is to share the burden of choice with other people.