funny how that works.

Lissa has a post up on her impending Lasik surgery, which made me realize an interesting circumstance:

Lasik and plastic surgery are two procedures that are not covered by insurance plans, and therefore almost entirely subject to market supply and demand.   If I want to believe the common criticisms of free market healthcare, Lasik and plastic surgery should be expensive as sin, since the providers can pretty much charge whatever they want.

Yet Lasik and plastic surgery become more affordable with each passing decade.  When my friend Joerg had Lasik ten years ago, he paid almost twice what Lissa is paying now.  In addition, I can call most Lasik providers or plastic surgeons, and I can guarantee you that I won’t have to wait very long for an appointment.

Imagine that: a health-related service that’s subject to the whims of the market…and it’s affordable and available.


20 thoughts on “funny how that works.

  1. pdb says:

    The Mrs had this done back in 2000, and we paid around $4k per eye. So in 9 years the cost has halved while the price of everything else has gone up.


  2. Tam says:

    And many docs will be happy to arrange financing! (As their ads proudly proclaim.)

  3. […] Munchkin Wrangler funny how that works. November 19, […]

  4. Lissa says:

    Thanks for the link, Marko! Also, as Mike dropped in my comments, I probably should have mentioned the additional tax implications — because we can take the money from FSA dollars, they’re pre-tax dollars. It’s a discount of 30-40% off the cover price.

    Cheaper surgery + Keeping dollars back from bloated government = Happy Dance!

  5. perlhaqr says:

    I’ve tried using this as an example, but somehow, to the true believers in CommieCare, it’s just not valid. Because it’s not about health care, it’s about bankrupting rich people.

  6. Jeff says:

    “I am OZ”

    Hasn’t anyone told you not to pull back the curtain… there is nothing interesting to see there!

  7. kneil says:

    And even as the prices trend down, the procedures keep improving.

    These markets areobviously need more regulation so they will stop making everyone else look bad.

  8. Madrocketscientist says:

    You see similar trends in cosmetic dentistry, and in veterinary medicine. I am still amazed that I can take my dog in and get her a set of X-rays and a blood panel and pay no more than $200.

  9. Anna says:

    But you also seem to forget that THOSE procedures, unlike most in medicine, are entirely voluntary and unnecessary. They are truly subject to the free market because the patient has the time and ability to shop around for the best doctor. The best procedure. The best price. Or to wait as long as it takes for prices to come down.

    When you’re taken into the ER for, say, a bear attack, you don’t have the option of pricing out the best of the best doctors. You are forced to take what you get.

    You can’t shop for prices. You pay what they tell you that you owe. You can’t even go step by step asking what each medication costs and weigh the cost-benefit of each because you were attacked by a fucking bear and time is of the essence. You certainly can’t stand up and say “I’m going to wait to have this head laceration closed until market forces bring down the cost of sutures” or “I really would like to wait to see where rabies shot technology goes in a few years so I’ll hold off on the vaccine for now”

    If we could actually shop for all medical care the way we shop for elective procedures, the system would be just great.

    But as it is, the free market can’t apply in a system where the customer is forced, at the risk of death or bodily harm, to buy whatever product is offered. That market can’t ever be free.

    • Marko Kloos says:


      you have to wonder why all those vets and plastic surgeons and opthalmologists don’t go into emergency medicine, where they can force people to buy their services…

      Any medical procedure is essentially elective. You elect to have health insurance, or go without. A lot of the people complaining about not being able to afford health insurance don’t have any problems making the payments on two cars, a four-bedroom house, lunch every day at Applebees, or three new Xbox games for Junior every month. (Those truly too poor to pay for health insurance are already covered under a number of programs that are taxpayer-funded, like Medicaid…and there’s a federal mandate that requires ERs to treat people regardless of ability to pay, which is one of the contributing factor to the extremely high cost of emergency care. Those who can pay their bill and/or have insurance get to subsidize all those who can’t/don’t.)

      Here’s why your intentionally limiting comparison doesn’t add up: the emergency responders and trauma surgeons don’t force you to buy anything. They perform their service in advance, and hope you (or your insurance company) will pay them for it. Nobody is going to kick you out of the ambulance or shove you off the OR table if you don’t have a credit card or health insurance card in your pocket. Most hospitals even let you pay off the bill if you don’t have insurance and can’t afford to pay it all at once.

      • Tam says:

        Nobody is going to kick you out of the ambulance or shove you off the OR table if you don’t have a credit card or health insurance card in your pocket.

        Speaking as someone who’s seen the emergency medicine system from the wrong end, I can verify that nobody even bothered asking how I planned to pay for any of this until I was out of the OR and checked into a room. They didn’t know whether I was indigent or John Edwards’ latest mistress, they just patched my ass up and worried about who to bill after the bleeding stopped.

        • mike w. says:

          Yup, same here. No one asked about insurance or the $100 co-pay until I’d been stabilized.

          And of course there’s also walk-in clinics, which will let those without insurance pay directly for services, either as a lump sum or through some form of payment plan.

    • To follow you logic a tad further, Anna, all we really have to do is regulate the price of that X-ray they gave you while you were unconscious (after being brought in to the emergency room on a stretcher after being T-boned by a Government Motors vehicle). We regulate the price to a slight premium over what a normal X-ray would cost, had you been able to shop around and pick a provider based on price, availability, and travel distance.

      For the 95% of all other medical care, we can turn the teeming masses loose after giving them an incentive to price their healthcare. With the vast majority of people suddenly shopping for something they use to just price by their copay, suddenly there would be an entire “network effect” that would bring down prices and improve service for everyone.

      Allow me to plug my post from two years ago: The Purple Pill provides a perfect case in point for the health care price pandemic.

      It’s hard to believe that even after years of price distortions, there’s actually people out there that think socialized medicine is the answer.

    • Um, actually, the nice EMT leaned over me and asked, once the first morphine had kicked in, which hospital I wanted to go to, because they were on diversion. So I had the choice of institution-shopping about as soon as the uncontrollable screaming became controllable crying and pained noises.

      No, I didn’t get to price the morphine, or the hospital ride – though other patients, who are not lying crushed on the wet pavement do have that choice, and can decide if they can drive themselves, take a taxi, or need the ambulance – and that’s price shopping right there.

      But as soon as I was released to try to hobble on crutches to a friend’s van, I got to price whether or not to get the meds prescribed, price which GP I wanted to authorize going to which osteo and which physical therapist I wanted. The osteos are pretty stuck on their favorite places to get an MRI, but the prices and reputations were close enough it was a wash.

      And I did check around carefully, because I don’t have insurance. I also am still paying off the medical bills, because Idiot Driver’s insurance company is trying to play the wait-to-the-last-minute-before-court-to-settle game, but you know, even if they never do pay, I will still be able to pay all these bills off myself.

      So to say that the person screaming and bleeding can’t price-shop and therefore the system can’t be free, I find as silly as saying that because my car decided to emit large clouds of antifreeze-scented steam and I need it for work ASAP, the car mechanic market can never be free.

  10. Atom Smasher says:


    That’s not true. Sure, you’re purchase point in your examples is forced, but overall the market would still act to drive proces down if it were allowed to act.


  11. Jenny says:

    “affordable and available”

    …well, at least until the feds slap a luxury tax on every procedure they can paint as “rich folk toys” in order to give a nod of the hat to the whole “revenue neutral” promise.

    cynical? never. 🙂

  12. Dwight Brown says:

    “When you’re taken into the ER for, say, a bear attack, you don’t have the option of pricing out the best of the best doctors. You are forced to take what you get.”

    You don’t use your auto insurance policy to pay for oil changes, or other routine work on your car, either. Your auto insurance pays for truly catastrophic events.

    So why do we use our health insurance to pay for routine events, like checkups? Shouldn’t we pay out of pocket for our checkups, and leave our insurance to cover bear attacks and other catastrophic events?

  13. BT in SA says:

    For some of us – opting for elective plastic surgery – we will just take our dollars elsewhere. I was planning on having some elective surgery in February in North Carolina. Won’t be doing it there, now, if the abomination of obamacare passes. Come 2010 there will be a 5% “excise” tax on plastic surgery – the “botox tax” and I just refuse to pay it. I am guessing I am not alone. There are plenty of other places to go for elective surgery from physicians that have been trained in the States. Thailand. DH can have a golf vacation and I can have my tummy tuck in luxury at the SAME time. It may cost more for the “vacation” aspect of it – but I won’t be giving $585. of the additional “fee” to obamacare.

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