"the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket"
Although it dovetails with the well worn narrative on HN, this comparison fails due to the level of care.
Also, from the article comments:
"There are just a couple problems. In 2009, the French Society of Radiology equipment in France was critically undermining care, and the government was refusing to increase capacity, even though people at many emergency rooms couldn't get an MRI even if they needed one because the equipment simply wasn't available. So, yes, the French government has held down the price of MRIs in France...by not purchasing enough MRI machines that one is available at every hospital. If you need an MRI in France, you're rolling the dice that you would be able to get one in a timely fashion.
Second, some of the development of MRI technology happened in Britain. Most was performed in the U.S. Who is paying for the cost of development of this and other new technology and drugs? It's often not the people in places like Canada and France, where government controls hold down prices. Most of the cost of research and development is paid for by Americans. We pay perhaps five times more in the U.S. for some procedures than people in France pay, but the technology might not exist in the first place if we didn't pay this disproportionate share. Once the technology exists, companies keep charging as much as they can in the U.S. to recoup costs and to fund development of the next big thing in medicine, and meanwhile other countries in the world adopt the technology, gaining benefits from it without actually paying the costs. This is Canada, France, and much of Europe. Plenty of medical research goes on in these countries, but American consumers ultimately bear most of the cost. It's an unfair system in many respects, but it's what has kept medical research moving ahead for the last several decades."
> Although it dovetails with the well worn narrative on HN, this comparison fails due to the level of care.
The context is purely the model of provision; level of care isn't addressed.
> Second, some of the development of MRI technology happened in Britain. Most was performed in the U.S. Who is paying for the cost of development of this and other new technology and drugs? It's often not the people in places like Canada and France, where government controls hold down prices. Most of the cost of research and development is paid for by Americans. We pay perhaps five times more in the U.S. for some procedures than people in France pay, but the technology might not exist in the first place if we didn't pay this disproportionate share.
This is an interesting point, in that much of the technology is actually developed outside the US, but the very high prices which Americans pay may be funding some of the development. That said, drug companies, for instance, only spend in the region of 12% on research, less than they spend on marketing. This marketing spend is disproportionately targeted at the US, as it's one of the few countries which permits heavy marketing of prescription drugs directly to normal people.
"This marketing spend is disproportionately targeted at the US, as it's one of the few countries which permits heavy marketing of prescription drugs directly to normal people."
By few, you mean two, soon to be one. The US and New Zealand, and New Zealand has passed legislation to phase it out.
The US will be the only country in the world where you can be advised of your potential need for a prescription drug not by a medical professional, but by an actor on a television screen.
In a way this can happen (though i'm far from being sure it actually does...): the medical area is one where the prices are the most regulated. In the public sector the prices for an MRI are probably very largely fixed by the government (and more probably completely) and given that even in the private sector you need an authorization to build an MRI counting them mean the medium price will not increase too much and the public operators might have less arguments to ask the government for price increase. Of course that would maybe not destroy effects of offers and demand and I don't know which one would win in the long term. But remember that health is a very different market than commodities and trying to compare the economics of health vs. crews and bolts by using crews and bolts theory might not going to work well.
The lack of MRI is a big problem in France anyway. Regardless of the effect on prices (except maybe if they triple or something like that) having 100% more would be a lot better.
"the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket"
Although it dovetails with the well worn narrative on HN, this comparison fails due to the level of care.
Also, from the article comments:
"There are just a couple problems. In 2009, the French Society of Radiology equipment in France was critically undermining care, and the government was refusing to increase capacity, even though people at many emergency rooms couldn't get an MRI even if they needed one because the equipment simply wasn't available. So, yes, the French government has held down the price of MRIs in France...by not purchasing enough MRI machines that one is available at every hospital. If you need an MRI in France, you're rolling the dice that you would be able to get one in a timely fashion.
Second, some of the development of MRI technology happened in Britain. Most was performed in the U.S. Who is paying for the cost of development of this and other new technology and drugs? It's often not the people in places like Canada and France, where government controls hold down prices. Most of the cost of research and development is paid for by Americans. We pay perhaps five times more in the U.S. for some procedures than people in France pay, but the technology might not exist in the first place if we didn't pay this disproportionate share. Once the technology exists, companies keep charging as much as they can in the U.S. to recoup costs and to fund development of the next big thing in medicine, and meanwhile other countries in the world adopt the technology, gaining benefits from it without actually paying the costs. This is Canada, France, and much of Europe. Plenty of medical research goes on in these countries, but American consumers ultimately bear most of the cost. It's an unfair system in many respects, but it's what has kept medical research moving ahead for the last several decades."