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When have people argued that customers don't want to see price in healthcare? Seems insane to me. I also have no clue why you wouldn't want to price things out up front. Does it benefit the medical industry?
We had a guy arguing that, I remember ControlsFreak getting into a rather long fight with him over this. I believe the argument is something like "the number is fake anyway, so you don't need to see it".
So uhhh that's me. Intent here is to provide context not inflame drama so mods tell me if you think I should just delete that portion or just the whole comment.
Background - got in a loooooong argument with this guy which to my recollection involved neither of us covering ourselves in glory and involved me feeling my interlocutor was being deliberately obtuse and getting highly annoyed so I doubt the essential thrust of my point comes across well. Also not sure if it's appropriate for me to participate in this discussion since I blocked the guy for what I perceived to be him following me around complaining after the discussion stopped becoming productive.
That said, here's a summary of the argument: "the number is fake anyway, so you don't need to see it," (as you say!).
But yeah healthcare demand is typically excruciatingly inelastic which is a large part of it. Supply is also often inelastic in the short term. Add in all the usual complexities of the U.S. healthcare system and shit is a mess. It doesn't need to be, but it is.
The problem is that the cost to provide the healthcare, the price the hospital wants to charge the insurance company (and therefore you), the price the hospital actually charges the insurance company, the price the insurance company actually pays, and how much you are on the hook for are all totally different, often completely unrelated to each other, and involve information that other parties don't have. Your health system can usually functionally guess how much your insurance will want you to pay for something but it's a guess and insurance companies deviate frequently and quite substantially. If the insurance company knows exactly how much something costs they'll low ball the hospital and the hospital will go out of business (we have a huge issue with hospitals going out of business right now).
Even if the hospital knew with perfect information how much the average procedure "costs" the hospital, and could predict how much the procedure will "cost" you (they can't) it still has no relationship to how much the patient actually pays because their insurance company decides that and they do whatever the hell they want.
You can choose to socialize things and make everyone pay an average for a given thing but Americans typically don't like that so it usually only happens with "safe" stuff.
Smuggled into here is the expectation that the doctor specifically and the healthcare system in general provide information about what another actor (the insurance company) will do. Hospitals already spend a ton of time and salary costs on trying not to lose a war with insurance. Adding more expectations to this will not help anyone and have a low degree of accuracy because fundamentally insurance companies will do the shit they usually do like randomly change which inhaler they'll cover with no warning.
Physicians themselves having awareness of some of the specific numbers is possible in an environment like one guy only doing total knees with a few major insurance companies but that doesn't usually happen. Asking us to know quickly balloons into a time consuming, pointless, inaccurate mess. We'll usually try and keep track of some things that can be leveraged into value for a patient (like which beta blocker is cheapest for your insurance) but this has the risk of becoming rapidly inaccurate and is questionable when you are considering giving someone something less effective to save them money. Is the patient equipped to truly understand the tradeoff? Do you have time to consent and document this in a way that doesn't create risk of later lawsuit?
Messy.
As a practical matter I assume most people want this so they can say spend less money on their colonoscopy, but again their is a lot of inaccuracy and false sense of security that can be driven by this.
Let's say you try three GIs and you get a quote of 5k, 10k, 15k being charged to your insurance or you. The 15k guy says he knows your insurance and they are in network and will for sure only charge you a 20 dollar copay.
What are some possible outcomes?
Maybe you take up 15k guy, go in for your procedure and he has to do a stat case and he offers his partner. You are exhausted from the bowel prep and don't want to spend another day shitting yourself so you say sure. Wait this guy isn't in network! Full bill. If you are lucky they'll notice this in advance and tell you but you might not notice because at this point you are sick, but realistically some random intraop nurse saying "hey do you want this done today or nah" isn't going to catch that problem.
Maybe you want to self-insure and pay the 5k guy. It's a colonscopy the pricing std is going to be pretty favorable. Okay but you have a cardiac event during the procedure and are now on the hook for millions of dollars (wouldn't quite work this way but I'm trying to keep the examples constrained). Maybe your insurance covers 5k guy and you go with that but it doesn't cover the replacement anesthesia because they aren't in network or the cost of your adverse event.
Ultimately the problem is that it's hard to give numbers in general, it's harder to make them accurate, nothing the hospital can do can guarantee the numbers are accurate, they are therefore not very useful in the vast majority of situations and also have a very real cost to deliver to a patient (in the form of literal costs in staffing to generate the numbers and in negotiating costs with other actors).
I might be a simpleton (it is very likely, in fact), but I don't see how this is any different from any other industry that faces uncertainty (which is all of them), where the prospect of telling the end customer "you don't need to know the price" is typically seen as absurd.
For your case to be persuasive, you'd need to do some comparative analysis, and show how the kinds of uncertainty faced by the medical field is much larger or fundamentally different from, say, car manufacturing or agriculture.
If making the numbers accurate being impossible / comes with costs, how can insurance companies function to begin with? Their existence hinges on having reasonably accurate numbers for these things. If they do have accurate numbers, I don't see how passing them to the customer would generate edtra costs - we have computers these days!
And if it's all really so arbitrary, is there any point to this system? Would anyone really notice if the whole healthcare system got nationalized, with Stalin's reanimated corpse in charge?
Many don't like this but you can't really function in our system without having insurance and this has been attempted to be enshrined in law.
The reasons for this are many but some things to keep in mind:
-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.
-Insane fuck off cost overruns are more common and possible in medicine than in other areas. Compared with say car insurance - the number of cars on the road worth over a million dollars is incredible small. 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). You can just not drive. Everyone has health and the lack of it - and it can become phenomenally expensive to manage through no fault of your or own or fault of your own. Getting a liver transplant or ECMO is a multi-million dollar endeavor.
Between those three things healthcare does not resemble any other industry. It's probably most similar to national defense in its fundamentally "non-economic" nature and that's why both of those things are usually run by the government.
But We Don't Do That Here.
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.
Those sound like arguments for price transparency, not arguments for the impossibility of determining pricing to the end consumer.
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.
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.
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?
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.
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