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PaperclipPerfector  21hr ago (text post)   3306 thread views

Culture War Roundup for the week of August 25, 2025

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Medical care is one of the most inelastic things arounds. If you need something or you will die that's a pretty good thought experiment for what perfect inelasticity looks like. For things that are less inelastic (primary care appointments say) usually not doing it is the actuarially wrong decision and demand should be more inelastic.

Patient's aren't the ones paying. Insurance pays. "Randomly" your insurance or the health system or some weird combination of laws and policies screws you. The government tries to close these but it turns out to be really hard to do for a variety of reasons.

Those sound like arguments for price transparency, not arguments for the impossibility of determining pricing to the end consumer.

Your chance of crashing into one of those cars and somehow being on the hook is one in a million. Major complications of surgery are 1%-10% depending what we are talking about, certainly orders of magnitude more (yes I know I'm missing some things about car insurance for the sake of simplicity)

As long as these are reasonably predictable, you can calculate a price. The specific issue you're talking about might mean that the price is higher, not that it's impossible to give an accurate number.

Also - now insurance companies can use fancy computers and actuarial tables to even things out and stay functional but if you tried to do this directly with health system you may end up with something like: "hey this thing should cost 100 dollars but instead it costs 4000 because that guy over their refuses to stop drinking soda and vodka instead of water." People get pissed by that in the U.S.

That could be an argument against price transparency, but not an argument for the impossibility of providing accurate numbers. Even then, this point can be argued against, it's not like it's unheard of for regulators to tell companies which factors they're allowed to take into account when making their calculations.

As long as these are reasonably predictable, you can calculate a price. The specific issue you're talking about might mean that the price is higher, not that it's impossible to give an accurate number.

Doing these necessitates a bunch of complicated questions. Do you refund people if they "use" less? Can you charge them more if they "use" more? Is it fair to charge someone 4k instead of 100 dollars because of an alcholic? If we are going to make everyone pay in and pay out according to who uses it why not just simplify it and make it socialized medicine which is the logical solution?

Developing accurate numbers is complicated, time consuming, and expensive and puts hospitals at financial risk due to insurance shenanigans. If you make it voluntary they'll do it where it makes sense like they do now. If you make it mandatory you need to put a number on how much you are willing to increase healthcare costs to do that and answer some of the questions above with respect to what to do about it when it fucks up.

Doing these necessitates a bunch of complicated questions. Do you refund people if they "use" less? Can you charge them more if they "use" more? Is it fair to charge someone 4k instead of 100 dollars because of an alcholic?

That's just a restatement of your third argument, and it does not show how calculating the price is impossible. These sort of calculations take place in most industries all the time.

If we are going to make everyone pay in and pay out according to who uses it why not just simplify it and make it socialized medicine which is the logical solution?

That was my original question, if you remember, and you asking it makes no sense. For one, socialized healthcare is the opposite of "pay in and pay out according to who uses it". For another, how is the government supposed to allocate the healthcare budget, if calculating the prices is so impossible?

Developing accurate numbers is complicated, time consuming, and expensive and puts hospitals at financial risk due to insurance shenanigans.

Insurance is already calculating the relevant numbers, they can just show them to their customers / the public.

Insurance is already calculating the relevant numbers, they can just show them to their customers / the public.

I don't think this is accurate. Insurance knows how much it costs to insure someone in aggregate and where to set their premiums.

They do not know how much stuff actually costs a hospital in aggregate (they attempt to guess and knowledge of this is extremely valuable to the insurance company and extremely detrimental to the hospital). They know what the hospital claims the stuff costs them in aggregate. Often the hospital doesn't know how much it really costs because even though they can add up everything they spent money on it is incredibly difficult to breakout what was spent on what because how do you account for things like admin costs. Do you spread them equally over all departments? Do you try and track what department those admin were spent working on (expensive, hard). How do you account for all the salaried people taking on extra work for no additional pay like physician committee work. Hospital employee a lot of people, a lot of types of people, many places will account for things differently than each other.

All of that is the aggregate stuff.

Nobody knows how much many types of individual things are going to cost a specific patient because the error bars are so large. You also have stuff like "this patient is ready for a downgrade to rehab but the insurance company isn't approving the prior auth because it is Labor Day. Does that suck? Yes. Does it need to get paid for by somebody? Yes. Is the insurance going to pay for it? Usually. Is that hard to calculate when giving cost estimates? Yep.

Sometimes the insurance company is increasing the costs for no reason other than their own inefficiency!

In short medical billing is hideously complicated and doesn't work like anything else and that should be trivially obvious because of what healthcare is necessitates that it not function like other economic activity.

Attempts to criticize or change it should necessitate some Chesterton's fence type thinking.

I don't think this is accurate. Insurance knows how much it costs to insure someone in aggregate and where to set their premiums.

Do you think when you're buying a hot dog at a stand, they're charging you the price of that particular hot dog, or the aggregated price within a particular time-window that the stand owner is operating in?

I think we need to go back to basics - it seems trivial to me that healthcare doesn't function as a market and doesn't work like other non-governmental activities. I provided a few examples of this in my replies.

If we can't get on the same page about that I'm not sure we'll be able to talk productively.

Major complications of surgery are 1%-10% depending what we are talking about, certainly orders of magnitude more (yes I know I'm missing some things about car insurance for the sake of simplicity)

As long as these are reasonably predictable, you can calculate a price.

I don't think that's true at all. You can calculate an expected value, but 90%+ of patients won't understand that. If you tell them the price of a procedure is $2000 dollars, but the typical/median price is $1000 and the max is a million, how are they supposed to use that information?

If these numbers are well understood, I wonder if you could buy "procedure insurance" instead of general insurance.

As long as these are reasonably predictable, you can calculate a price.

I don't think that's true at all.

I'm sorry for being pedantic, but how does that mean what I said is "not true at all"? You literally just gave an example of a calculated price. Someone might not now a median from their ass, but you can tell them "just look at the expected value, bro". They can then use that information to compare with other providers.

I mean in the sense that doesn't match the meaning of 'price'. Conceptually a price is a fixed value that you will pay, not a variable. If you come in my store and ask the price of a sandwich, and I tell you $10, and then when you check out you're expected to pay $15, you would rightfully tell me I lied about the price.

Which is why you'd charge me the expected price to begin with, and deal with the variables yourself, maybe adjusting the prices every couple months as the situation calls for it.

You definitely would not tell me how it's impossible to calculate the price of a sandwich, because maybe the fridge breaks down that week and you might need to buy a new one.

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