No, they are definitely overpriced. But it’s impossible to know the doctor’s profit margins on retail boot sales. So I see no evidence to blame his pricing policy. Perhaps his markup is excessive, but it’s equally possible that his retail profits are slim and your money actually ends up in other hands.
This wonderful encouragement of horse trading is how our elected representatives want to pay for health care. It’s certainly not a system dreamed up by the orthopedic surgeon you’ve targeted. You want to point a finger, then point it at voters.
The US system is great for patients who want doctors to try everything that might possibly help them, even a little.
To take a random example, consider the treatment of glioblastoma. This is the uniformly fatal brain tumor that killed John McCain. In the US, about 70% of patients receive surgery+chemo+radiation and only 1% go untreated. In Taiwan, only 50% of patients receive surgery+chemo+radiation and 10% go untreated. And in the US, treatment options include newer chemo agents that aren’t available in Taiwan.
Patients who undergo surgery or get the latest drug might live a little bit longer, but the disease is terminal regardless. And glioblastoma patients are usually elderly to begin with, a few extra months of life is lost in statistical noise when you look at the overall health of Americans and Taiwanese.
Neurosurgery (often multiple rounds) and the latest drugs are very, very expensive. So is it worth spending a lot of money to buy just a little extra time? Your answer likely depends on whether you live in the US or Taiwan.
EDIT: Another example just popped into mind. In the US, annual screening mammograms are recommended for women as young as 40. In France and Germany, mammography is recommended biennially, starting at 50. In the UK, it’s every three years for women over 50.
Who is right? Depends on whether or not your goal is to detect as many cases of breast cancer as possible. Because the last one you detect will be far more costly than the first one.