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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.
I'll once again note that various excuses about how a treating physician probably can't really know what things cost ring hollow for anyone with a decent veterinarian. That end of things is admittedly a newish experience for me, but when I take my dog to the vet and he presents treatment options, I can inquire what they cost and his reply is, "about [$X], but I can get the exact number for you if you want". That physicians cannot do this for much narrower ranges of practice indicates an incentive structure for not knowing what things cost.
I genuinely believe this is the part that triggers so many people to feel the way they do about Luigi. Guys like Brian Thompson make tens of millions of dollars and if anyone has a problem with it, they can get their lawyers to take it up with his lawyers, who will all make a shitload of money arguing with each other, lying for hire and making arguments that no one actually believes and that most laymen can't even understand. I'm surprised that others are surprised that profitable Kafka rituals occasionally trigger rage.
I've expressed before that veterinary care has a lot of medicine, especially the business side, figured out better than humans.
Insurance, for the most part, really is for the big stuff that can't be anticipated, and is priced as such. It's $60 a month to insure my 14 year old beagle with 50% coinsurance. It doesn't cover the cost of exams or checkups. It does cover things like surgeries and cancer treatment.
I once used it for a spine surgery. The total cost was about $7,000, quoted upfront. I paid about $3,500 and the insurance covered the other half. This would have been well into hundreds of thousands of dollars if performed on a human.
I was able to have conversations via email, not through some dumb HIPAA compliant portal.
That most dogs are uninsured probably keeps costs down, as does that typically pet insurance has a higher coinsurance figure than human insurance. There's an unavoidable principal-agent problem that we exacerbate with regulations that practically remove all incentive for people to price shop.
Why did you get insurance with a co-pay of 50%?
Insurance is good if it prevents improbable but huge payments. It has a negative expectation value on your net worth, but should have a positive expectation value on the logarithm of your net worth (presumably defined inclusive enough that the case of going negative does not appear), which is closer to actual utility. LW recently had an article on this, here.
A fixed co-pay seems reasonable enough, the case you want to avoid with insurance is paying hundreds of thousands of dollars, and if you co-pay is a few thousand, then that limits your risk exposure.
But an insurance with a proportional co-pay feels different. I mean, if it is 1% co-pay, one could still argue that it scales the treatment options one can afford by orders of magnitudes. By contrast, a 99% co-pay would not be worth it for anyone, because if you can afford 99%, you can also pay 100%.
I would argue that 50% co-pay is more like 99% co-pay than 1%. If X is the maximum loss you could absorb, it will only be helpful for losses between X and 2X. For example, say you could absorb losses of 5k$ without insurance. Then for any treatment which ends up costing up to 5k$, you would have been better off to just absorb the losses in case they appear without paying a middle man. And for everything which costs more than 10k$, you could not afford your co-pay and thus would not benefit from insurance. Now, if it happens that most vet bills are in that range, then it could still make sense to buy it, but from my priors, they are likely much wider in distribution.
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Which is certainly what it should be for healthy people. A high deductible catastrophic plan. But the ACA outlawed that and instead young healthy people have to buy expensive insurance that they largely don't use.
It's called a health sharing plan. They exist mostly as religious exemptions to ACA requirements to cover the morning after pill, but nobody actually checks whether you go to church or not.
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Your rate sounds not to far off from what a cash pay health sharing or a ultra high deductible plan would be- and that’s basically what you have.
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How much has your pet insurance paid out? Seems that unless you're having major procedures regularly, self insurance is the way to go.
Roughly $5,000, dog had another surgery later on to remove a bunch of tumors.
Got the dog in 2018, at about $60 per month since then, I'm still ahead, but that's very luck of the draw. I'd prefer not to have some other incident that would make the insurance pay out and deliver more value for my premiums, I'd rather he just die in his sleep when the time comes.
These products are regulated and competetive, I expect the rates to be actuarily fair and the median customer to have been better of self insured.
That doesn't make any sense. For an insurance to exist as a business, they have to take more then they're giving to the average customer. They have to pay for offices, ads and personnel. Maybe you got lucky and are temporarily ahead financially, but long-term insurance will always result in a net negative for the customer.
I think we agree.
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I’m curious if survival rates are similar? That is, if the margin for error is much smaller when operating on humans it makes sense to me the cost may be orders of magnitude higher
Even if survival rates are similar, a dog's life is worth less than a human's in court.
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