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There was a wild post on r/RealEstate yesterday. It's already been deleted.
There's obviously a good chance that it's a totally fake story. I'd basically assume that it is. I don't even really care if there's even a 0.1% chance that it's actually true; it doesn't really matter.
Part of the reason why people likely believe that it's fake is that it sounds like absolutely outrageous behavior by the contractor. Something that no one would put up with. Something that would shock the conscience if it actually happened and there was a recording of the interaction or something.
So what's weird is that this is the standard modus operandi in the medical industry. It's just the way things are done. Yes, if you have insurance, then instead of telling you to your face that they're charging a ridiculous made up number after the fact, they tell your insurance provider the same thing. But the basic fact pattern is absolutely the same.
I'm definitely not going to go all Kulak and say that since this routinized obscenity shocks the conscious, everyone needs to start going around murderin'. But it absolutely is a routinized obscenity that should shock the conscience. Perhaps my crazy pills are significantly less potent than his, but they appear to still be crazy pills.
Lawyers can debate the legalese of "consent to treat" forms and what they do and do not allow, but it simply cannot be plausible that we will have a functional medical industry when it is the one and only industry that is allowed to simply refuse to provide you a price prior to authorizing work and then go on to just make up whatever the hell inflated price they want after the fact.
That's entirely believable to me.
Dealing with reputable HVAC contractors in my area, quotes ranged from $13k-35k for the same job.
A drywall contractor my dad barely showed up while continuously demanding new progress payments. He kept claiming he was too broke to finish the job without getting paid, couldn't afford gas to get to the job, the job was in worse shape than expected, etc.
Construction / building works in general are one of the last industries where if you don’t personally know (and are friends with, and can afford to pay well in most cases) somebody competent to oversee building works, you’re pretty fucked.
Seconding this- construction has lots of A) crooks and B) drug addicts. You can find honest people who do good work, but as a complete layman you don't really have a way to do so.
Seems ripe for disruption by a large conglomerate which lets tradespeople syndicate with them and verifies they are not A) Crooks or B) Drug addicts. It gives them a certificate of approval and then they can use that to prove to prospective clients they are decent and thus get more work, no different to how any certification regime (that's not been captured) works at the moment.
On a small scale, things like Angie's List exist. I've used them a couple times and was happy.
On a larger scale, my guess is that there is a lot of laundering of immigration status that happens which a large company might not be able to do.
But finally, honest contractors do exist. Both my brother and parents did a complete rebuild with a contractor and were not in any way screwed over. Honest ones may be hard to find, however, since they will get so much positive word of mouth they will quickly have a full slate.
Angie's List, as it once was, hasn't existed for years. It's now basically just an advertising service for contractors.
Yeah, it's called Angi. I've used it twice and both times got services at a reasonable price. If I had bad service, I could have rated the contractor which would have made it less likely for them to get future work. And it also saved me from having to call 50 places for my $200 job that no one would have wanted.
I know this is an internet forum and it's cool to be jaded. But, I don't know, this corporation provided value to me 🤷. I wish there was an Angi for health services.
Their is. Sort of - and they fucking suck.
The industry has essentially landed on patient reviews as the mechanism to do this and you can find all kinds of websites that track this, and certain forms of reimbursement may be partially contingent on patient satisfaction metrics.
The first layer of problems is the usual review issue - most people don't bother to leave a review if they had average care, a small fraction of people who receive great care leave a review, and a lot of people who are mad leave angry reviews, this creates a lack of realistic balance in the reported experience.
The other piece is that what makes for good care isn't usually legible to patients. NPs like to brag about studies where they have higher levels of patient satisfaction and it's often tied to not appropriately saying no to patients or things like unnecessary testing and treatment. People don't like being told "no" or "I don't know" doctors are better at doing that but it pretty uniformly pisses people off. The classic example is telling a patient no when they ask for antibiotics for a viral infection. This is good healthcare but obviously decreases patient satisfaction, and that's not bringing up things like angry patients seeking drugs of abuse and review bombing, or psychiatric patients who are angry because they have poor insight and received good care.
Outside of outpatient clinic medicine things get even trickier. The best hospitalist in the hospital is spending his time not in the room with you running down to pathology and radiology, calling insurance companies or social workers for dispo, teaching students, etc. The worst is sitting in his office playing Sudoko. Both only spend five minutes with you a day, you'll have no way to tell if they are good or not unless you have an avoided near miss or something like that.
I was hospitalized a little while back at my own hospital and was the victim of a pretty severe and unacceptable/easily avoidable medical error. I don't think a non-doctor would have even noticed.
Some other examples - anesthesia.....you'll wake up either way, the horribly wrong outcomes aren't generally the doctor's fault. With good gas you'll have an easier emergence, or if you know exactly what to look for on your anesthesia record you could see you were getting good care. How many people get enough surgeries or have the training to read those tea leaves?
For surgery... a lot of aspects of outcomes are patient and not surgeon dependent (like overall health status, engagement with PT), you don't know if your insides are an avoidable mess afterwards or not. The good surgeon might make your next surgery much much easier but you are unlikely to ever know. Patients will also often jump at the chance to get surgery not realizing when NO surgery is the better outcome. You might be a better doctor for saying no...and get worse reviews.
Exceedingly hard to manage this.
There have been attempts to look at more formal outcomes and this rapidly runs into pretty severe juking stats and perverse incentives.
A classic example is transplant surgeons forcibly keeping patients "alive" to get them to die outside of various thresholds (since that gets reported).
Surgeons will sometimes refuse to operate on risky cases because of the morbidity and mortality outcomes. Some of the best surgeons have the worst outcomes because they'll swing on cases that others won't. Some of the worst surgeons too - they'll swing on cases that they shouldn't.
It's a mess.
I do get asked "how do I find a good doctor then." I don't have good advice for this. In my specialty and my area? I already know who is shit and who isn't and hoard that knowledge like gold. Some related specialties? My specialty further away than I don't know them personally? Sometimes I can guess, but mostly I just have to know someone in that specialty in that region who has the wisdom to be able to determine which of their colleagues are ass.
That is not generalizable.
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