AEIdeas

The public policy blog of the American Enterprise Institute

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Discussion: (55 comments)

  1. I can already sense somebody saying something about shopping around for the cheapest surgeon for a facelift not being a great idea.

    Those surgeons compete not only with each other but with alternative technology that can perform non-invasive and much less expensive facelifts (unless you look like a Shar Pei). Moreover, since there isn’t a third party payer, they compete in the global market.

    1. morganovich

      well, shopping around for the cheapest car might be a bad idea too, right? you’d be safer in a bentley than a ford focus.

      shopping based ONLY on price is almost certainly a bad idea, but no one in their right mind does that. this “cheaper healthcare must be bad” strawman seems ridiculous. pretty much every good or service exists at multiple quality levels and price-points. you pick the one that makes sense to you and best matches your wants. health care is not any different.

      1. I’m telling you, Morgan, the very same people who claim that Europeans are paying less for better socialized medical care will be screeching that it’s dangerous to consider price when choosing a cosmetic surgeon.

        And yes, you can get plastic surgery of comparable or even superior quality but for a much lower price outside the U.S.

        1. And yes, you can get plastic surgery of comparable or even superior quality but for a much lower price outside the U.S.“…

          Hmmm, I’m beginning to wonder about that anymore…

          Obviously at one time there was no doubt about it, one could more easily afford to have quality plastic surgery at lower prices almost anywhere but here and maybe some western European countries…

          I think technology is now changing that equaltion…

          Someone I’ve known since grade school who specializes in ophthalmology technology says the cost of cosmetic eye surgery which for the most part is not covered by most typical health insurance plans has dropped to less than 50% or more over the last five to ten years is mainly due to new technology…

          Maybe its health insurance and how it works (due in large part I’m guessing to federal government interference) now a days…

          1. Peter McIlhon

            For the record, one of the reasons that South Korea has such a high rate of plastic surgery is 1). Because LOT’S of Koreans (men AND women) get procedures from nose jobs to eyelid lifts done in Korea, and 2) Because many Japanese women fly over to Korea to get similar procedures done much more cheaply – which inflates the instances of surgery but also is a signal to not only clinics within Korea but clinics in nearby countries like China and the aforementioned Japan.

          2. Funny thing peter I hadn’t given much thought to those sorts of cosmetic surgery you refered regarding the Koreans even though I’m sure that is much more common than what I was thinking about…

            Three years ago my mother was told by her insurance company that a new method to treat cataracts with lasers was considered ‘cosmetic‘ surgery but the older methods were not…

            After doing a little bit of arithmetic it was obvious that not only was the laser method far cheaper but one needed much less time to recover from it…

            When my mother was first diagnosed with the problem the laser method wasn’t widely available…

            Mom got the surgery done for a $1K per eye whereas typical methods of cataract surgery are quite bit more expensive…

            The results are rather amazing…

      2. Most of the results I have seen are more of the Ford Focus variety. I know the good ones you’re not supposed to tell, but get them to crack a smile (if you can) and it becomes obvious. For men, I hear calf and chins are a big seller.

        I wonder how much of the video-chat phenomenon has boosted sales in facial-area proceedures?

        1. morganovich

          moe-

          there might be some selection bias there though, no?

          i mean, if you get a really good facelift or breast job, no one may realize you did it. (unless they knew you before and see the difference)

          bad cosmetic surgery/botox is easy to spot, but the good stuff is not.

          a quick and dirty porn star boob job is obvious, but a sub muscular one is not.

          might it just be that it’s easier to spot the bad stuff?

          1. I can only tell when the sun hits your face at just the right angle…
            :)

          2. morganovich

            just so long as the pec implants look natural.

          3. Stick with the light colored Manziers and you’ll be fine.

          4. morganovich

            manziers make my pirate shirts look funny.

  2. chuck martel

    “which introduces competitive, market pressures and transparent pricing that don’t exist in most other areas of healthcare.”

    Cosmetic surgery isn’t health care.

    1. morganovich

      chuck-

      we can quibble over definitions, but surgery is surgery be it implant breasts, stents, or spinal hardware.

      the fact that cash pay gets more affordable while insured procedures less so is a strong indictment of the current insurance system.

    2. Hummm. My dermatologist sent me to a cosmetic surgeon to have a melanoma removed so the scar wouldn’t be as noticeable.

    3. Tell that to somebody with a cleft lip or a woman whose breasts are so heavy she’s in constant pain.

      But even if we generously let you play with definitions of “health care” (not as easy as you think, I assure your. The definition of “medically necessary” is super slippery), cosmetic surgery and certain other cosmetic procedures are medical procedures performed by the same medical doctors who undergo the very same medical training as your family physician and your heart surgeon. There is no reason other medical procedures shouldn’t be subject to the same market forces and result in the the same increase is outcomes and decrease in price.

    4. John Dewey

      Chuck,

      Perhaps we need to distinguish cosmetic surgery done to enhance appearances from the other work done by the very same surgeons.

      My wife has worked as an operating room nurse for the past 36 years. Much of the work performed by plastic surgeons she’s worked with is actually reconstruction of faces and other parts of the body following accidents and diseases. Reconstructive surgery is definitely health care.

      It is true that the number of procedures performed for beauty enhancement far exceeds the number of reconstructive surgeries. But I’m pretty sure that the reconstructive surgeries require a lot more operating room time per procedure.

  3. related to what Chuck Martell mentioned above: “Cosmetic surgery isn’t health care,” I’d say this is an important point as it relates to elasticity of demand. The ability for a person to say no to most cosmetic surgery is one of the reasons prices have increased at a much slower rate. One can live without fixing that ugly bulbous nose (or at least take a long time to shop for best price)… but they can’t live with with a burst appendix, fractured femur, or a brain aneurism. The fact that health care providers ‘have you over a barrel’ is why cosmetic surgery is not the same as health care.

    1. Jon Murphy

      Cosmetic surgery also includes having cancerous moles removed, wisdom teeth extracted, tonsils out, pretty much every kind of dental surgery. It’s more than just boob jobs

      1. chuck martel

        Tonsillectomies aren’t generally elective procedures and, since only your dentist or doctor will look down your throat, they’re not really cosmetic, either. If you’re going to continue in that vein maybe tattoos, circumcision and sexual reassignment surgery would qualify as health care, too.

        1. Jon Murphy

          I agree they aren’t cosmetic. That doesn’t mean they aren’t classified as such.

        2. Jon Murphy

          And yes, circumcision and sexual reassignment surgery are classified as health care, too

          1. chuck martel

            There’s some interesting semantics vibrating through this thread. Moving on from the definition of “health care” we encounter “classify”. When you say that circumcision and sexual reassignment surgery are “classified” as health care, who is providing you with that particular classification? Maybe it’s the government that does the classifying. Or the AMA. Or Webster’s 3rd.

            Does a new-born boy classify circumcision as health care? But he’s not consulted in the matter, is he? How is this barbaric practice justified in any terms, including health care? If you’re into statistics, find out how many adult American males undergo circumcision annualy. Isn’t there even now a moral repugnance in the west of female genital mutilation? But is it still health care?

          2. Jon Murphy

            When you say that circumcision and sexual reassignment surgery are “classified” as health care, who is providing you with that particular classification?

            I believe it is the AMA. They are usually the ones who publish these statistics, but it could also be the government.

            As to the rest of your comment, we’re no longer talking about health care, are we?

          3. morganovich

            chuck-

            what a bizarre standard. if a newborn gets antibiotics or heart surgery, was he/she consulted then? does that make it not health care?

            lots of health care procedures that we would not consider barbaric or ridiculously harmful were once performed with the best of intentions. calomel purges, mercury, bleeding, the list goes on and on.

            hell, that’s how benjamin rush killed george washington.

            in 50 years, chemotherapy may wind up being considered a dangerous and reprehensible quackery. “you gave you patient poison to cure him?”.

            but it’s the standard of care we have now.

            medical procedures become outmoded all the time. that’s the nature of progress. so what?

          4. morganovich

            sorry, that should say “now consider barbaric” not “not”.

            typo.

          5. chuck martel

            My mistake, I was unaware that having a foreskin could be a cause of death for the newborn.

          6. Jon Murphy

            My mistake, I was unaware that having a foreskin could be a cause of death for the newborn.

            It absolutely can. That’s why so many tribes going all the way back to the ancient Hebrews have a child circumcised at birth. Early on in a child’s life, the foreskin can be very susceptible to infection; it used to be fatal, but like many diseases nowadays, it’s quite treatable.

          7. morganovich

            chuck-

            again, that’s a preposterous straw man and a total dodge of the issue.

            a cleft lip is not life threatening either. is it not health care to fix one in a baby?

            how about fixing webbed toes or removing a vestigial tail?

            you sure seem anxious to try and muddle this issue.

            so, to be healthcare it has to address a life threatening issue?

            for someone trying to plead semantics, you sure seem to be trying to hide behind some absurd ones.

            further, as jon said, there are health benefits to circumcision including lesser chance of STD transmission, hygiene etc.

            “The American Academy of Pediatrics (AAP) says the benefits of circumcision outweigh the risks.”

            but it also says it’s really up to the parents.

            http://www.mayoclinic.com/health/circumcision/MY01023/DSECTION=why-its-done

            you seem to have some weird emotional hot button here, but the standards you are laying out for “healthcare” are absurd.

            having a cyst removed from a baby’s face is neither consented to by the baby nor addresses a life threatening issue. but it does improve quality of life for the child.

            how is that not healthcare?

          8. chuck martel

            According to always reliable Wikipedia approximately 2/3 of the male world population retains its prepuce. Since this is an unhealthful and possibly fatal situation for those unaltered men, the theories of Malthus are obviously incorrect for that reason alone.

          9. morganovich

            think of it this way chuck:

            would you consider getting a flu shot healthcare? how about a tetanus inoculation?

            of course you would. they are a health choice to reduce susceptibility to disease. personally, i think flu shots are stupid and unnecessary, but i still think they are healthcare. if i got the flu a lot, i might feel differently.

            circumcision also reduces the likelihood of disease.

            http://www.cnn.com/2012/08/27/health/circumcision-policy/index.html

            “Scientific research shows clearer health benefits to the procedure than had previously been demonstrated. According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life,” the group said.

            so what’s the difference?

          10. chuck martel

            OK, this has been a real divergence. The purpose of the blog entry was to contrast essentially elective procedures (cosmetic surgery, however defined) with procedures generally covered by third parties in economic terms.

            However, other commenters are expanding the parameters of health care just as the government itself and the health industry have done. Justifying seat belt requirements, gun regulation, soda consumption codes, fast food labeling, birth control availability and on and on, based on “health care”, is simply an intrusion on individual rights. Certainly unfortunates with a cleft palate or some other serious deviation from normal, whatever normal might be, should have the opportunity to correct it.

          11. Jon Murphy

            I’m sorry, Chuck, but I guess I don’t understand why you do not consider these elective procedures the same as health care? They are still performed by doctors, they still require follow-up visits, most require some kind of medication.

          12. Chuck, but I guess I don’t understand why you do not consider these elective procedures the same as health care?“…

            jon where is the ‘health care‘ in something that is ‘elective‘ versus something that might be required for continued health or life?

            Now obviously there both ‘medical treatments‘ but…

            Is there an implication here that typical health care insurance should cover what would be considered ‘elective‘?

            Just curious is all…

          13. Jon Murphy

            Is there an implication here that typical health care insurance should cover what would be considered ‘elective‘?

            Personally, I think it should not. Insurance is meant to only cover rare unexpected costs (cancer treatments, emergency surgery, bone repair, that sort of thing). If something is elective, I do not think it should be covered, at least not entirely. But I do not run a health care company.

            I am just trying to understand Chuck’s point. Why shouldn’t elective procedures be under the same umbrella term as “health care”?

          14. Whether or not we call any particular procedure “health care” may be less important than the fact that it’s mandated in the coverage plans we can get, whether or not we want it. I would prefer greater choice in customizing the types of medical treatment I want to prepay or risk share.

    2. morganovich

      jason-

      not really. i think you have missed the point here.

      you cannot live without food either. you need shelter.

      these are not really optional (at least in most climates).

      does that mean the grocery store has you “over a barrel”?

      no. pricing is transparent. you see what things cost, compare them to other stores, and make price/quality decisions.

      that is what makes cosmetic different than insured care.

      it’s the incentive to shop because you actually face the costs. it’s also the demand modulation created by people actually paying for what they use.

      let’s imagine an example.

      let’s say that for $400 a month, you can get “grocery insurance” that, after your $500 annual deductible, pays for 80% of your grocery costs.

      do you think you would shop differently as a result? i sure would. i’d be far more ready to consume expensive things. if the incremental cost of a 2.5 pound lobster was $6, hell, i’ll take a dozen and have the neighbors over for dinner. at $30 a lobster, i might be far less inclined to do so.

      of course, lots of us would feel that way.

      this would rapidly drive up the price of lobster, no?

      imagine how much worse this would be if it were zero copay like medicaid.

      if i gave you a government paid amex black card and said “go to the grocery and grab what you need” imagine your consumption decisions then. would you even look at prices at all?

    3. I hate to break it to you, but “burst appendix, fractured femur, or a brain aneurism” are not what makes up the bulk of what gets counted as “health care”. You seem to be under the delusion that health care are only those things with which one can do without, but this is so obviously wrong, I’m left wondering why you made this comment at all.

  4. Derek Tomczyk

    I’ll point out the obvious here. Cosmetic surgery is elective, you can shop around and compare, pick the best price, and if nothing fits, opt out. Can’t do that so much with head trauma.

    1. Derek, in an emergency, you’re stuck with what’s available. However, emergency medicine is not the bulk of medicine and there is absolutely no reason at all that providers should not compete for health care dollars. In fact, your emergency care will be cheaper if they do.

  5. It’s not clear what procedures per 1000 population really means. Does the Economist chart indicate that South Koreans get more aesthetic procedures per capita or merely that more aesthetic procedures are performed in South Korea?

    1. South Korea had about 650,000 cosmetic procedures in 2011. With a population of about 50 million, they had about 13 procedures per 1,000 people. (650,000 / (50,000,000 / 1,000)).

      1. Thanks Mark, in other words 13/1000 S. Koreans had procedures, not medical tourists traveling to S. Korea for surgery?

        1. John Dewey

          I doubt that the number of cosmetic procedures in the statistics provided by the Economist are separated by the patient’s country of residence. I’ve never seen a report from a U.S. hospital which made such a distinction.

          As Peter McIlhon notes above, many Japanese patients fly to Korea to take advantage of the lower prices.

          1. John

            That was sort of the reason for my question, but I must have been mumbling. If S. Korea is a popular medical tourist destination, then the number of procedures per 1000 population has no useful meaning. It tells us nothing about the propensity of S. Koreans to get aesthetic surgical procedures.

            Likewise for every other country’s statistic.

          2. Well, it doesn’t tell us “nothing”, but it certainly doesn’t give us a clear picture of how many Koreans living in Korea are getting procedures (anecdotally, I understand it’s a lot).

      2. OK, OK, “It tells us nothing little about the propensity of S. Koreans to get aesthetic surgical procedures.”

        :)

  6. Dr. Perry’s remark highlights a fundmental flaw in the US healthcare system. Nobody knows what the procedures actually cost and so nobody can make an informed decision on what procedures they should perform by doing a cost/benefit analysis. Consumers routinely do this sort of analysis on purchases, but unless you know the costs, its hard to perform.

    Its like a restaurant with menu’s without prices.

    This, IMHO, was at the center of Obama’s attempt to force all insurance plans to cover birth control for women. My guess is there are some new BC pills that Big Pharma wants to sell for big money each month, but they know very few women will pay big money for a pill that works the same as they mom’s pill for $10 a month. The answer – get someone else the foot the bill and then market the hell out of the new pills. The result is big profits for big pharma and businesses and insurers picking up the tab.

    1. BC pills are $30-$60 per month without insurance. In other words, they’re not expensive. The appropriate pill is usually found through trial and error in conjunction with an OBGYN. It’s a hormone. The side effects for an individual will determine which pill that individual will take. No woman will take a pill that makes her feel suicidal or packs on 20 pounds of unwanted fat regardless of the marketing. Third parties shouldn’t be forced to pay for reproductive choices (or for anything else), but most health insurance plans already cover the BC pill, the BC pill is cheaper than a pregnancy, and I think there are larger profits to be made elsewhere.

  7. PeakTrader

    I wonder how fast prices of dental procedures rose.

  8. PeakTrader
    1. PeakTrader

      “…skin disorders, like acne or dermatitis, which accounted for 42.7 percent of the doctor visits.”

    2. chuck martel

      The county seat of Olmsted County, Minnesota is Rochester, headquarters of the famed Mayo Clinic. The residents of this county, many of whom are personally involved in health care, are much more aware of their medical options than those of say, Koochiching County, where pimple infestations might rank behind axe wounds, lyme disease and frostbite.

  9. I’m a Cosmetic Surgeon myself and I’d love to see some statistics like this for the place I’m from (Chennai, India) but I guess we’re too a small a market yet, for companies to collect data!

  10. Read “The Freedom Plan” by Dr. John Perry, (available on Amazon), It’s a well thought out path out of our health insurance “crisis”,

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