Lowering the cost of health care - another Detroit billboard

In the spring of 2009, as the health care "debate" was starting to brew, I saw the above billboard on Interstate 75 in Oakland County, Michigan. The county, encompassing Detroit's Northern suburbs where Dr. Rifai's practice is located, is the fourth wealthiest in the nation among counties with over one million residents.

According to a Discovery Health Article, in 2007 the average national prices for the procedures listed on the billboard were as follows:

..................2007 National Average...... 2009 Dr. Rifai ....Difference(%)

Breast Augmentation: .....$ 3,816 ...........$ 3,400.............. ( - 11%)
Tummy Tuck ...................$ 5,264 ...........$4,900............... ( - 7%)
Liposuction .......................$ 2,982 ...........$ 2,000.............. ( - 33%)

This may seem like an apples-and-oranges comparison but even those can provide some valuable information on what's not happening.

First, consider the fact that the comparison is for surgical procedures in 2007 vs 2009. Given the continuously rising cost of medical services, we should expect that the 2009 prices (Dr. Rifai's) be higher.

Second, the comparison is for the average prices in the US against the prices offered in the fourth wealthiest large county in the nation. Again, it would be a reasonable expectation that the prices offered in the rich market would be higher than the national average.

Finally, the the same Discovery Health article states, "costs in the big cities tend to be higher than in the rural areas" which gives us yet another reason to expect Dr. Rifai's prices, in a major metropolitan area, to be higher than the national average.

Contrary to all these reasonable expectations, they're not. Why? Could Dr. Rifai's practice be an exception? It's possible. Could it also be that, not covered by medical 'insurance' policies, most elective plastic surgery procedures are paid by consumers out-of-pocket? And since consumers pay directly the full cost of the procedure, they feel motivated t0 shop around, creating a truly comeptitive market for plastic surgery, where unfettered competition by providers brings prices down over time? Such a competitive market is not so unusual, folks. It happens with iPhones, and gaming consoles, and food, clothing, cars, airplane travel...

Competition is the only way to reliably and sustainably lower prices for products and services. In the current debate on health care there's absolutely no talk of creating competition among the providers of medical services (contrary to popular belief it is not your insurance company that provides your medical services). Until you can shop around comparing prices various doctors charge to fix your broken leg the same way you can shop around comparing prices for your liposuction we are not going to get the cost of health care down.

(I'd love to hear from any of you who have seen a price list for medical services... If you ever walked into a hospital or a doctors office and were offered a price list, please send me an email at atleastonewhy@gmail.com)