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Seems like they’d be even more money-grubbing assholes.
Not a problem. We'll just have a pogrom every once in a while to take back our money and let off some steam.
I'm joking obviously, but the way that people on Reddit are talking about this murder is frankly concerning. These simpletons think that the reason health care is fucked up is because of insurance company profits, and if only the CEO was less evil everything would work out. Worse, they are fine with murdering this person because of their own incoherent beliefs.
Well:
I don't think everything would work out for everyone if the CEO was less evil, but I think a strategy of vigorously denying claims at an exceptional rate is actually pretty evil and destroys a lot of lives in service of increasing margins. That the CEO being less evil wouldn't solve literally everything in healthcare access and funding isn't exactly a defense of the CEO being evil.
Yeah - what happens with a denial?
Well I can appeal, and often the appeal is successful, but generally what will happen is that they'll tell me we'll have a call at X time, which means I need to reschedule or be late to appointments, maybe skip my lunch or charting time, or even stay late. I'll sit on the phone for an extended period of time and then have a retired outpatient OB nurse who has no fucking clue what she is talk about go "oh yeah sure that's fine, we'll approve" or "wow I don't know about this, let's schedule another phone call with a relevant specialist, but I'm going to deny or now" or whatever other insane shit they do.
The goal is to make paying for things as inconvenient and expensive as possible. That means less time spent on actual patient care and more burnout and exhaustion in physicians.
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There's a reason far-left governments turn into skull factories within 5 minutes of coming to power. It may be concerning but it shouldn't be surprising. Once Reddit (or similarly far-left dominated communities) manage to coordinate deciding that some individual or group be put to death, they're not going to be quiet or subtle about it.
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Curious, why doctors rather than hospital administrators?
At least hospital administrators pay attention to how much things cost.
In many cases, doctors literally do not know how much the treatments they provide cost. This means that they simply don’t do any cost-benefit analysis. They will prescribe an expensive brand-name drug instead of a generic drug that does basically the same thing for no reason other than because they heard about it more recently.
Why is it the physicians job to know what things cost? A hospital will literally have hundreds of employees whose full-time job it is to figure out what things cost and deal with insurance companies, who are always changing things constantly. Even a small practice will usually have 2-3 employees minimum who spend most of their day figuring that stuff out.
It's entirely orthogonal to providing good medical care.
We do cost benefit analysis all the time, but it is in terms of the risks and benefits of a given intervention, wouldn't you rather us be focusing on that?
I don’t know at what point this went off the rails, but you both eventually end up sounding like assholes. @ControlsFreak, you’ve been specifically warned for arguing with this exact poster! One or both of you needs to make use of the block feature.
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If you're not capable of doing it, then you need to figure out a workflow so that someone who is capable provides a price. This is a part of basically every other service in every other industry; it is not impossible.
To go to the auto shop example, you could equally imagine a mechanic-head praising the beauty and sanctity of the Art of
MotorcycleAutomotive Maintenance, and how carefully he considers the non-monetary risks/benefits of a given intervention, saying that in his view, the price is entirely orthogonal to providing good automotive care. He could be so educated and experienced that he thinks it would be an utter waste of his time to even put together estimates. I would say that perhaps he is right on all those points. I still want a price. I want it as a routine matter. Maybe he will have some customers who literally don't care, who have a unique, historical vehicle and a fat bank account, and they just want the artistic approach, damn the costs. But as a routine matter, I don't care how beautiful you think your orthogonal things are; you are running a service business where the customer needs to know the costs/benefits. It is doubly important in the medical domain for them to be informed of the costs/benefits if they're going to give informed consent.If you need to structure your workflow so that a different employee is up front assembling the estimate while the genius mechanic is spending every minute of his time on his craft, so be it. You have people that do that stuff anyway. Do it up front, not after-the-fact. Keep your patient informed. Just give him the damn price.
I'm curious as to why you think it would ever be in the best interests of the medical industry to provide price transparency.
Like, obviously they could develop ways to formalize price estimates and communicate them to customers. If anything, that's confirmed by the poor quality of the countervailing arguments in the thread below. But why would they ever want to?
Having the ability to inflate prices without reducing demand, because nobody at the point of consumption has any idea what anything costs, seems like a pretty sweet situation. Likewise, high salaries and various other forms of grift and waste across healthcare are made possible by the broader cultural perception that the industry provides priceless, sanctified Human Care Through Science rather than some mere grubby service like your hairdresser or auto mechanic. Giving patients the power to participate in rational cost-benefit analysis about their healthcare seems like it'd work out worse for every single level of the industry.
Total price opacity almost certainly is a benefit to the medical industry currently. As you mention, from the rest of the conversation, it's pretty clear that they have chosen this path, and it's likely because they think that it is in their own financial interest. I am extremely sympathetic to game theory arguments, and it is completely legitimate to ask why they would ever willingly give up their grip on the market.
The first, most obvious answer, is that it is the right thing to do. Doctors claim to hold themselves to high standards when it comes to informed consent. They are clearly failing miserably on that score when it comes to informing their patients about the financial parts of the costs and benefits.
Of course, one can easily observe that those sorts of considerations often get ground into dust upon first contact with the raw ability of a cartel to enrich themselves. So, a second possible reason would be if enough cultural argumentation is built up to force the conversation about informed consent and prices at a high enough level. Embarrass them, as they talk in circles. They will have to weigh the monetary gain against the loss in status as more and more people realize that they're lying and violating their stated principles in order to enrich themselves.
A third possible reason could be lawsuits to change the regulatory landscape. I've seen some lawsuits going on against hospitals who are using their boilerplate "consent to treat" forms that they use at intake to justify absolutely every charge that they choose to make, regardless of whether the patient actually agreed to that particular thing. We'll see if they go anywhere.
I described some additional possibilities here. One of the most likely possibilities is just that they are forced to change via regulation. This is not preferred, as the regulatory process is often a total mess, and it's not super likely that it will result in a truly coherent way of doing things, but when there is this much pent-up outrage at how things are currently done, it is entirely plausible that the government will just drop a bomb on them and force them to make some set of changes, regardless of whether it's in their interest, or whether those changes even make much sense.
As I argue in the linked comment, I personally think that the probabilities are trending in a way such that if they don't clean up their act, something is going to happen that is going to blow up the whole thing, with potentially highly unpredictable results. I mentioned similarly seeing the writing on the wall for the real estate and IoT industries. From a pure self-interest point of view, they have to weigh the value they would lose by voluntarily cleaning up their act in smaller ways now (in an attempt to reduce the probability of a regulatory bomb or something like that being dropped) against the expected value they'd get from a period of sticking with their guns until a bomb gets dropped plus whatever mess they get after.
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There are multiple parallel problems here.
The cost is fundamentally unknown. It is reasonable to determine what the average cost of a thing is, but that is not helpful information because when we leave the average the costs can become profoundly immense. More people are upset with an estimate that is off by multiple orders of magnitude than by no estimate at all, and that will happen.
To torture your mechanic analogy, it's like if you go to buy a car and ask for a Corolla, but 5% of the time you get a Bentley whether you want it or not.
The average cost is not necessarily known to your doctor. If I'm your surgeon I know what my professional fees are and how long my average case takes. I probably know the billing codes used, if I'm business minded I may know something about the average cost of supplies, instruments, and equipment. However a run of the mill routine surgery requires a team of 40+ people between the office visit, PAT, pre-op, intra-op, PACU, and post-op. It is unbelievable how many hands are involved and it is incredibly difficult to keep track. You immediately start running into problems like "cleaning staff are a critical part of the OR and are a cost to the hospital but are not usually considered a part of the surgery, is that a cost or is it not a cost?" or "does this facility charge by the minute for anesthetic gases or use a flat fee" both options are viable, your anesthesiologist probably knows, your surgeon probably doesn't. Keep track of "costs" is a full time job with an entire department just for the OR. Your surgeon might be able to say "your surgery probably costs 10k" because they asked someone in a billing meeting what all the averages on the spreadsheets said, but nobody wants to have a 20 minute conversation about how much of an oversimplification that is.
Additionally that is fundamentally not the surgeons job and does nothing to improve the surgeons provision of medical care. We evaluate whether to perform a case or not based off of the medical risks and benefits, not the cost. This is part of why healthcare is expensive in the U.S. but most people prefer that to the alternative.
Doctors wear a lot of hats. Things like increased regulatory burden and the dance with insurance below mean that you have of multiple departments involved in figuring out how to deal with the above. We already do a lot of things like that slow us down and prevent us from actually spending time with patients. Making it worse is not desirable to us or our patients.
The cost is irrelevant, which disincentivizes processes involved in streamlining all these things and makes it useless for your doctor to know and be able to relay to you. Almost all procedures are paid for by insurance or involuntary charity care by the hospital, with a small rarity of actual self-pay. Getting insurance to pay for something involves complicated negotiations where they try and pay you less than "cost" so you exaggerate cost as much as possible in hopes you don't actually lose money. It is not uncommon for the payment mix to end up being something like medicaid reimbursing 80% of cost, medicare 85% and private insurance 110%. If you mostly care for medicare and medicaid patients you go out of business (which has happened a lot lately) or require government bailouts. This is why the sticker price is so insane, and hospitals will almost always drop 90% of the bill if you end up being cash pay. You have to negotiate with the insurance company and that involves the "official cost" of a gallbladder removal being 100k instead of 5k or whatever.
A surgery has more in common with a government procurement and bidding process than getting a car repaired.
Even more simple things like an office visit are a pain in the ass to figure out. Unless you are doing very specific types of PCP practice or outpatient cash Psychiatry you are taking insurance. Therefore I don't know what the visit costs. I know what my billing team will try and charge for my time, they'll use the specific office visit billing code, I'm told to make sure to put X and Y thing in my note so they actually cover the work I did, but then I know that even the insurance company is supposed to pay for that code they'll make a big stink about it and require hours of the billing teams time going back and forth to make sure that its not worth it to actually get paid for that, even though the other insurance company always takes it if I put in X and Y, so my office staff will adjust the coding and bill you for the down coded visit even though that's not what I did and that's somewhat illegal, and your sister will get billed the actual billing code because she has "better" insurance.
All kinds of asinine shit like that happens for the most routine interaction with healthcare.
This is why psychiatrists are like "dude just pay me 100 an hour and we are good" and why there are now multiple forms of primary care that avoid working with insurance.
"What's my rate for a visit" is never a viable question because every insurance company pays me differently and its constantly changing year to year and I'm effectively only paid for by insurance.
As minimum they should be obligated to answer yes/no questions like "is consulting with this specific doctor covered by my health insurance"
If that is too risky to answer I guess they can insure themselves.
Or force health insurance companies to make legally binding answers.
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This is false, as we've already discussed.
I don't care whose job it is. Every single other industry has figured out how to do this basic business practice in a decent way, and many times, there is division of labor.
This is the most pernicious, absolutely atrocious lie that is the core reason we have such a disaster of a medical industry. You cannot believe that anyone will read this entire thread branching from the OP and think that this a remotely reasonable response. Sure, if we just accept that everything is broken with insane prices that don't mean anything, then nothing means anything and we're doomed to dysfunction. We can do better.
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It seems like the natural control group is veterinary medicine, which is fairly cost conscious by nature. Veterinarians have similar education requirements. What's the difference between veterinary medical costs and human medical costs for routine things(let's exclude end of life care for obvious reasons).
That should be a natural ceiling to how much of healthcare costs are inflated by cost-insensitivity.
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Doctors will also just blithely lie to you and make stuff up. They'll tell you to your face, in the exam room, that something is totally covered, but as you say, they have no idea whatsoever. You have to either force them to have someone actually verify it (which will annoy them, as they'll view it as just a waste of their precious time), or roll the dice and hope to not get slapped with a huge bill after the fact (that could be literally anything, could be gigantic enough to make whatever the service is completely not worth it to you).
I've said it before, and I'm becoming more obstinate about it; the entire medical industry is absolutely addicted to complete and total price opacity. This is only one of the many dysfunctions, but it's a big one. Forcing them to put their prices up on some website, in a way that would require you writing your own JSON or whatever parser, make your own interface, and still not be able to figure out what the price is because the doctor can't even tell you what the procedure code is... has simply failed as a "price transparency" law. I would be open to literally any other solution that anyone can think of, but I can't think of any other than simply forcing them to give you a price. Could declare that patients cannot exercise legally-valid informed consent to a procedure unless they've already been provided a price, in writing, for example.
EDIT: Forgot to add that when you call up the billing department to ask, "What the hell? I thought this was supposed to be covered?" they'll just bluntly tell you that the doctors don't have a clue and that "they probably just guessedsorrybut not sorry enough to have you not pay this".
I'm not sure I fully understand this, even a car mechanic won't give you a price up front, they'll give you an estimate, and sometimes, even with a machine, a repair doesn't go the way they expect, and your bill is higher than the estimate. Are you asking for medical care to have set, up-front pricing unlike car repair, or are you saying their estimates are significantly worse / harder to get?
This bit. They won't even give you an estimate (or they might just lie to you). Sometimes, they'll claim that it's "impossible for them to know" (that's a fun one to get into; they try to hide behind the fact that an insurance company will be involved; just wait, I'm sure someone will try to jump in here and claim this). And this will be the case even for many procedures that are pretty standard, without much likelihood of something happening.
I'd be perfectly fine with the same sort of, "Looks like you've got a bad CV joint; we're gonna replace that, and it'll cost this much," with an always-implied, "...and if we get in there and see something else, we'll let you know." Just tell us what you plan to do, what you plan for it to entail, and what the price will be for your plan.
I mean it is impossible to know. You know how much an average thing costs more or less, but a bad outcome or routine complication can make the cost 10x or 50x, or more very very easily, and that's just with the planned treatment.
If you find something incidentally that needs management then you start getting into the territory of "oh yes, you could later make a case that not treating this immediately led to the patients death and lawsuit" or "anesthesia is bad for you and has excessive risks, doing it now while the patient is under will improve recovery time and decrease overall costs." Costs are way more complicated than is typical in medicine because people have more variety than manufactured products.
And that says nothing about charges, your insurance company can approve everything or nothing for a variety of reasons that are constantly changing and may be appealable or not appealable.
Healthcare providers can't easily predict what the insurance company is going to do because of enemy action, and many things are not practical to be done via cash pay outside of sketchy situations because if anything goes wrong the patient is on the hook for a bill they can't pay and the hospital has burned a lot of resources.
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What mechanic are you going to? Every mechanic I've seen has standard prices based on hours worked and cost of parts. I mean if I bring in a car without knowing what's wrong with it, yeah the cost of "Make this car work again" is unknown. But with a known problem the cost is fixed and they can tell you the exact price to replace a transmission, change the breaks, swap out a strut, you name it.
They might have fixed prices but things don't always go to plan. Maybe something goes wrong and it takes them four hours to get at some part of the car, instead of one. Maybe they find (once they get in there) that the problem isn't just with part A, but also part B. It isn't typical that the final bill exceeds the estimate, but it isn't unheard of either. Diagnostics and repair are not an exact science and shit goes wrong sometimes.
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Health care is a bit more important than shoveling shit or working with the dead as well. People might be disgusted by that kind of work but it's unlikely it'd spiral into real hatred. With something as important as healthcare this caste could end up straight genocided, as people directly blame them for their ailments, and if the genocide failed they could end up a protected class with extra powers that controls a necessary and lucrative industry which would give them a lot of power over society.
I mean, health insurance also has human capital requirements that undertaking or shit shoveling don’t.
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