(1/) A video I replied to claims LASIK is cheap because it’s not government-controlled but “free market,” while insured surgery costs more because of “government” and “socialized medicine.” This sounds clever, but it’s deeply wrong.
Here’s why the comparison is bogus, step by step.
(2/) LASIK isn’t cheap because it’s a “pure market.” It’s cheap because it’s simple, standardized, and elective.
• One narrow procedure
• Low risk, short duration
• No hospitalization/ICU
• Predictable outcomes
That makes it easy to streamline and compete on price.
• One narrow procedure
• Low risk, short duration
• No hospitalization/ICU
• Predictable outcomes
That makes it easy to streamline and compete on price.
(3/) Everyone pays cash for LASIK. That means:
• No insurance overhead
• High patient volume
• Repeatable workflow
• Constant price competition
These factors drive efficiency—not the mere absence of government.
• No insurance overhead
• High patient volume
• Repeatable workflow
• Constant price competition
These factors drive efficiency—not the mere absence of government.
(4/) In contrast, insured surgeries (appendectomy, cancer resection, bypass) are complex, variable, and risky. They involve hospitals, multiple specialists, anesthesia, recovery, and sometimes ICU care. You can’t compare that to an outpatient eye laser.
(5/) Hospitals must be ready 24/7 for any emergency—trauma, stroke, cardiac arrest, births. Readiness has huge fixed costs: staff, sterile environments, ICU beds, compliance, backup power. Those costs are spread across all procedures.
(6/) Insurance adds another layer:
• Billing/coding complexity
• Prior authorizations & denials
• Negotiated rates
• Cross-subsidies for the uninsured
That admin stack exists to serve a complex system LASIK doesn’t deal with.
• Billing/coding complexity
• Prior authorizations & denials
• Negotiated rates
• Cross-subsidies for the uninsured
That admin stack exists to serve a complex system LASIK doesn’t deal with.
(7/) US hospitals are legally required (EMTALA) to stabilize emergencies even if a patient can’t pay. The cost of uncompensated care gets shifted to other payers. LASIK centers have no such obligation and can turn people away.
(8/) So LASIK vs insured surgery is like a car wash vs a repair shop that must fix anything, anytime, even when the customer can’t pay—and keep the lights on 24/7. Totally different business models.
(9/) The “government makes healthcare expensive” claim collapses globally. The U.S. is among the least socialized rich nations and has the highest costs by far. If government made costs “explode,” public systems would be pricier. They aren’t.
(10/) Countries with greater public roles and centralized bargaining (UK, France, Germany, Japan, Canada) spend far less per capita and deliver equal or better average outcomes (life expectancy, maternal mortality, chronic disease management).
(11/) If “socialized medicine” drove cost explosions, those systems would top the charts. They don’t. The evidence points the other way.
(12/) What actually drives high U.S. prices?
• Private-sector pricing power/opacity
• Lack of centralized rate negotiation
• Local hospital/insurer concentration
• Fragmented benefits and networks
• Administrative bloat
• Private-sector pricing power/opacity
• Lack of centralized rate negotiation
• Local hospital/insurer concentration
• Fragmented benefits and networks
• Administrative bloat
(13/) About those sky-high surgery figures: “list prices” are sticker prices for negotiation. Insurers often pay much less—but those discounts are hidden, inflating public perception.
(14/) Cross-subsidy is real. Hospitals charge more to private insurance to offset Medicaid/Medicare underpayment and uncompensated care. Again—LASIK doesn’t bear this legal or social burden.
(15/) Administrative overhead in U.S. healthcare commonly runs 15–25% (paperwork, billing, denials). Centralized systems tend to spend far less on admin because they negotiate once and publish rates.
(16/) Emergencies kill price-shopping. You can comparison-shop LASIK. You can’t shop an ER surgeon when your appendix bursts. Market pressure is structurally weak in urgent, complex care.
(17/) Hospitals also carry heavy capital/regulatory costs: robotics, imaging, cybersecurity, infection control, quality reporting. Those fixed costs are amortized across many services—not comparable to a lean LASIK center.
(18/) The video’s sleight of hand: treat LASIK as “the free market” and hospital surgery as “government failure,” then pretend one explains the other. In reality, they’re different markets with different risks and duties.
(19/) It’s like saying: “Burgers are cheap—why aren’t emergency transmission repairs just as cheap?” Different stakes, risks, and obligations.
(20/) Want lower insured-care costs? Focus on:
• Simplifying payment & prior auth
• Transparent/centralized rate setting (including drugs)
• Adequate safety-net funding to reduce cross-subsidies
• Enforcing competition where providers/insurers are concentrated
• Simplifying payment & prior auth
• Transparent/centralized rate setting (including drugs)
• Adequate safety-net funding to reduce cross-subsidies
• Enforcing competition where providers/insurers are concentrated
(21/) Also: standardize where possible (bundled payments for well-defined procedures), curb surprise billing, and align incentives toward outcomes, not volume.
(22/) Bottom line: LASIK is cheap because it’s simple, elective, high-volume, cash-paid. Insured surgeries are costly because they’re complex, lifesaving, and operate inside a system built to treat everyone—including those who can’t pay.
Blaming “socialized medicine” flips cause and effect.
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