This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
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.
Medicine is worse than that. There was some bureaucratic confusion about whether insurance would be available for my kid's routine visit. I asked at the front desk what it would cost, assuming a normal visit with no complications, in case I couldn't apply insurance. She didn't know. I asked her who would. Didn't know that either. Tried calling the billing department, no answer. Looked up the billing information the hospital is required to publish by state law. The 'common' bills they showed did not include checkups. So basically, I could wait months for a different appointment or I could tell them I was willing to pay whatever price they asked after the fact. It worked out.
Vets, dentists, and the Surgery Center of Oklahoma can all quote prices. Medicine could too. I always thought the rightwing's Obamacare should've been: hospitals have to have transparent pricing and insurance companies can only say to the customer, "We'll cough up X money for your procedure based on your prognosis. We'll incentivize you to spend less than X. You can pay more than X if you make up the difference. You are allowed to spend that money at any hospital." The government can maintain a crappy website that lets you do price compare, with the assumption that Amazon or Walmart would make the actual working website.
A big problem with medicine, along with other notoriously expensive professional services like law, is that knowing which specific actions to take is part of the service. One can't provide a remotely accurate quote without having already performed the services requested. A checkup for a 10-year-old boy with no medical conditions is a very different service from a checkup for a 58-year-old woman with twelve medications and diabetes.
I think that the original poster would be satisfied with a rough estimate for a checkup of the demographic of their kid, with the understanding that this is the money they are committing to pay, not the money it will cost to cure the kid of all ills. If at some point the checkup discovers the need for additional medical procedures, the doctor can simply quote their prices and ask if he should perform them, or if they would like to shop around more.
I mean, there can be procedures where they go "we cut you open, check what is wrong and try to fix it, and depending on what is wrong, this is going to cost you more or less", but even then they could state the costs of the hypothetical treatment options beforehand, with the patient opting in or out of specific treatments.
This works for a basic "checkup" type thing which is bounded, but in a "cut you open" situation, the higher end of the spectrum is "your vitals suddenly collapse and you have to be taken to the ICU for a week, that will be $300K". Nearly every surgery would have to have this as one of the possibilities.
Moreover, that's not one a patient could be realistically given an opt-out from -- they can't just leave you to die.
Absolutely correct. The correct lens to look at this through is informed consent. Patients must be reasonably informed of the known costs/risks/benefits of medical procedures at the point when they give consent. Prices are part of costs, so they need to be reasonably informed of them when they give consent.
Of course, when they're lights out and cut open and something happens, there is no opportunity to inform them of the medical costs/risks/benefits, so we reasonably say that in such situations, it is acceptable to proceed anyway. All you need to do is import the exact same considerations to the question of when you can skip informing them of pricing information. If you feel ethically comfortable not getting informed consent for the medical costs/risks/benefits, sure, go ahead. Otherwise, when you're informing them to a reasonable extent about the medical costs/risks/benefits, you also need to inform them to a reasonable extent about prices. Just tell them what you're planning and what you know about that plan.
Oh definitely. I think that's fine.
I think the other bit is that up-front, the estimate for any surgery with anesthesia is going to be "it's unlikely but as we discussed there are risks in anesthesia and so in the worst case you nearly die and it's gonna be $300K".
Sounds fine to me! Maybe not even strictly necessary to put numbers to all the things. Again, it's just informed consent, just like medical costs/risks/benefits. You can say that there are risks in anesthesia, that unknown complications can happen, and if they do, you'll do what you can (where the actions and price are yet unknown). However, in some cases, where it's a "routine" complication, you can advise a little better. One doctor in these forums suggested that there are some procedures where they know that something happens about 1% of the time, that they plan for it, that they know what they're going to do if that happens (e.g., "If we see X, we're going to remove Y also"). In those cases where you have reasonably known specifics with reasonably known, planned actions, what you do is inform the patient. You can likewise inform them with reasonable information about likely costs of that relatively-known event and following actions. I think people would be perfectly happy with that.
All of this is getting into what is a common situation in hospitals, but is relatively rare for individual patients and in terms of total patient interactions with medical billing. It's kind of an edge case, though it is important to put some thought into. I think people would be pretty fine with a variety of practices concerning informed consent in these edge cases if the industry started getting the basics done on the much more vast world of much more numerous, much simpler services.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link