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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.
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?
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.
I'll also chime in here that this is not how most auto shops work. Probably not all of them; who knows what Jim-Bob is doing up in the hills. But most places are "flat rate" shops. They list their labor charge as $X/hr, but the way they figure out the amount of the actual charge is not by setting a stopwatch for when the mechanic starts/finishes the job. The history here is that many mechanics would get paid a direct portion of the shop rate (say, P% of the $X/hr that is billed). A lot of places still do this to incentivize the mechanic to get more stuff done and make the business more money (usually the final pay being determined as the minimum of either their labor charges for the pay period or a different hourly rate for on-the-clock time; e.g., they could get paid $20/hr for on-the-clock time or $45/hr of billable labor).
But obviously, it would be dumb incentives for them to be able to start a job, lollygag, take an extra few hours getting it done, and rack up the money. Instead, what the majority of shops do is just use a "book" (a computer these days, for sure) that estimates how long it would take an average mechanic to do that procedure on that car. That determines how much they quote/bill the customer... and how much the mechanic will get paid for that billable labor. This is extra incentive for the mechanic to work hard. If he can be more productive than the average book rate (e.g., he can get a three hour job done in two and a half, then start another job and rack up more billable labor hours), he can make even more money.
I will admit I have no insight into the inner workings of auto mechanics, as I experience it only from the customer side. I was speculating as to what might happen, but I can say that I have had auto shop bills come in higher than the estimate. So whatever the cause might be, it does happen.
Of course it happens. Most people are mostly okay with it happening sometimes, because they got an estimate, were told what the plan was and what the estimate was based on, were able to make an informed decision, and then were told what happened and why the charge was higher. Often times, we would call people when we ran into something that we saw would increase the price and tell them what was going on and if they had options. Many customers are price conscious, and you had to be communicative. If you were, and you made sense in your communication, they're mostly okay with it.
Contrast with the medical industry. Most consumers aren't nearly as price conscious, probably in part because they hardly feel like it's even an option to be1. (There are other reasons, more cultural, but one would have to get off on a tangent about Robin Hanson's terminology of the sacred/profane.) They just go to the doctor, do what he says, and magically a bill goes through their insurance company... and maybe they have to pay some of it. If they bother to inquire, there's a half decent chance they'll be told that it's impossible to know anyway. Every part of it is completely the opposite of the pro-active, communicative pricing information that even only half-decent auto shops provide. If we could get the median medical provider to have price transparency resembling the 25th percentile auto shop (with similar allowances for some situations to happen sometimes where final bills are higher than the estimate, but with similar communication), I'd be super happy. I think this is pretty possible to do.
1 - Yes, and some patients are in situations where they really really really aren't price conscious at all
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