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Hi Dr Belk, my father is a Gastroenterologist based in India and has been to the US quite a number of times for various reasons. As you know healthcare in India is way cheaper than US, and many times for the same quality of care.

What I understood from my conversations with him was, the American system, as in the protocols, staffing and processes are the main reason for higher costs. Eg. A stent in US is bought by the patient (not per se) and after its use is thrown away. In India, the stent is provided by the doctor and is reused (if possible). Similarly, in an American intensive care, there is an epidemiologist, physio therapist and many other "ists" I haven't heard before, ready to attend the patient. In India, the doctor to patient ratio is far lesser. Similarly the amount of disposables consumed are are also several times higher per patient in the US.

Doesn't these explain for the higher costs at hospitals (not medical care in general) in US?

I feel, pointing out what a procedure's raw cost is the toughest thing to do and like you said, $1000 is very difficult to arrive at due to the various fixed costs associated. Eg. If there are 2 hospitals: X & Y. X may be of different size hospital and hence their initial costs of setting up the hospital may be very different from Y.

When you cap a procedure at $1000, you are saying that, X can make a maximum of $100 and Y makes $200. That means the investors of X have no reason to keep their money in X and will prefer to goto Y because Y is more profitable.

How business is done is, before you build a hospital, the no. of surgeries are estimated after studying the market and then the price is decided upon based on the returns the investors expect.

So when you cap prices now, you are disturbing the whole business flow and logic and I think this is what is preventing the capping from happening.

PS: I mean no offence to you or Dr Belk here. I am just trying to draw a logical counter which I hope will help you folks address this challenge better.

Hi Sir,

Are you really convinced that Julian Assanage did the right thing by handing over all the cables and other data to big establishments like the Gaurdian when in the first place he declared himself to be up and against "establishments."

Many are of the opinion that the actual top secret information about internet privacy breach has not been leaked by these news agencies. What do you think?

I get your point Dr Belk. But I believe the differential pricing could be due to various reasons like differences in economies of scale, operational efficiency etc. I believe we should account for those and look for data for a solid back-up

A serious answer: It is nothing but common sense that similar products and services vary in pricing because of the reasons I stated. Right? So I pointed that out. I like to question the logic of experts because I think that is what differentiates the experts from the rest and questioning it helps in understanding their flow of thought.

To be honest, I was not convinced by Dr Belk's answer because I felt the reply I gave (which you questioned) is a valid justification to the claim that inconsistent pricing is exposing overcharges