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NYT Continues Medical Pricing Beat
They're starting to get closer.
It is well-known that the NYT will plan out long-term foci for sustained coverage, taking their own perspective, keeping it in their pages in a variety of ways. I've covered a few in recent months; this one is in the "Your Money" section.
The piece focuses on the author's experience with his wife's mastectomy for breast cancer plus reconstructive surgery and the role that prior authorization played in it. What's that?
Why? The only reason they describe comes from their characterization of the insurance industry's response:
I'd like to steelman the idea of prior authorization by rolling it into my own perspective that I've been trying to sustain over time.
The fundamental principle is that prices matter to patients. This statement simultaneously seems trivial and is also quite profound in context of the medical industry. There are doctors even here on The Motte who have sworn up and down that prices don't matter, but frankly, they're just wrong about this. This NYT piece reinforces this basic principle, though it does not state it quite so forthrightly.
That is, the story of the article is that, two days before the planned surgery, the author and his wife
This was disconcerting to them, which is somewhat strange if one thinks that prices don't matter. It seemed to matter to them. He writes:
Contrary to what you might have heard doctors say, that prices don't matter because patients can't possibly make choices with price information, they actually can. Here are actual people, considering making the choice to skip a possibly life-saving surgery, because they have uncertainty concerning the price. I've pointed before to another, doctor-written op-ed in NYT that acknowledges this reality:
It also tells the story of an emergency room patient, in quite bad condition, that the author really felt should be admitted as an inpatient. The patient was concerned about the possible cost. No one could tell him anything. He chose to go home that evening.
Prices matter. Patients will make choices based on prices. Patients will make choices based on uncertainty about prices. This week's NYT piece drives this home with yet another example, this time concerning a surgical procedure.
They ultimately decided to go through with it, and it turns out that the author managed to talk to a billing specialist from the surgery provider while his wife was under the knife. What he learned:
Let's ignore the whackiness (and the veracity) of the claim that the provider would eat any uncovered charges for now. The article makes a fair amount of hash over the issue that they hadn't opted-in for electronic communications from their insurance company, so they only received a delayed snail mail, but the provider was notified earlier and didn't tell them either! Why not?
They are just sooo addicted to price opacity; it's ridiculous. The author is not buying it:
Prices matter. Prices matter. Prices matter. Get it through your thick skulls, providers and insurers. Just tell your patients. Tell them. They need to know. They're currently making decisions under uncertainty, and you can just tell them. The author closes with basically this exact plea:
Just tell the patient what's going on. Just tell them the price. Do it before services are rendered.
Ok, with the basics out of the way, I should probably get around to that steelman of prior authorization that I promised. The fact of the matter is that there are going to be some drugs/procedures that insurance won't cover, at least under some circumstances. There's probably not a reasonable way out of this with a rule like, "Insurance must just cover literally anything all the time, no matter what." Obviously, there's going to be a spectrum, with some routine things being covered ~100% of the time, with others having significantly more variance. The useful idea behind prior authorization is that the provider and the insurance company should get together... get their shit together... and figure out what the price is going to be for the patient. And, frankly, that makes sense, especially for items that often have significant variance. It's hard to make hard and fast rules here, but my sense that many insurance companies have a list of items where there is significant variance and so they require prior authorization.
It is good for them to get their shit together. It would be even better for them to get their shit together more routinely and then to tell the patient what things are going to cost. It is a pox on both their houses that they haven't gotten their shit together. The old NYT op-ed was written by a doctor, so it's no surprise that they wanted to put all the blame on the insurance companies. This week's was written by just a guy, one of the journalists on staff, talking about his own experience, and he more rightfully pointed out that both providers and insurers are failing.
NYT is getting closer, but they're not quite there yet. They've given multiple examples of why giving patients prices matters, but they haven't quite figured out that they just need to beat that drum directly.
Tangent here.
Not only no, but fuck no. To this.
The quick little slip of "mental health" here is an exemplar of how insidious current perspectives are on the topic.
When (normie) people hear the term "mental health" they automatically connect it to images of depression, bipolar, maybe even schizorphrenia, along with PTSD etc. A "mental health crisis" might even conjure desperate scenes of attempted suicide or some full blown panic attack that necessitates the men in white coats arriving.
Whatever the specific circumstance, we're dealing with a disorder of some kind. Perhaps mood related, perhaps cognitively related, perhaps something more broadly endocrine (note: there are some cases of neurological issues, but I always roll my eyes when people use the term "brain chemistry" as it is both horribly imprecise and, more to the point, they're usually talking about the endocrine system as opposed to a brain (as in the grey matter, not the concept of mind) specific neurological problem")
These things are called disorders because they represent an unexpected and maladaptive response to normal life circumstances. Depression; "I have a good job, an active social life, stay in shape, and don't abuse any substances. I'm horribly sad all of the time. What do?", Bipolar disorder: "I have a good job, an active social life, stay in shape, and don't abuse any substances. But these mood swings are causing me to drink, miss work, not go to the gym, and alienate myself from people. What do?", Schizophrenia: "The Jew Aliens keep reading my brainwaves without my permission. What do?" (Okay, I had fun with that last one).
What the NYT author describes is categorically not a "mental health" issue. Getting an unexpected and alarming piece of mail should cause some level of distress. If you're totally incapable of dealing with that distress, my first response would be to question general maturity and life capability. A second would be to look at your specific life circumstances at the time to see if there's a charitable reason why you might be in a bad position to deal with such an occurrence. Only much, much later would I start to think, "Well, maybe this guy has an awful mental health disorder which makes it hard for him to deal with ... things happening and mail."
"Mental health" is not a species wide mission to prevent bad feelings from happening. Especially when the given circumstances would naturally provoke negative feelings. But this is yet another wonderful biproduct of the culture war; bad feelings have become pathologized as a) horribly disturbing and never to be expected b) worthy of full and unquestioning accommodation by ALL others and c) probably both someone else's fault and responsibility to deal with.
The author slips all of this in, easy as you please, by asserting that of course his health care provider obviously considers "mental health" to be as high a priority as sterile operating room conditions and well trained staff.
IMO this is society's brain on women.
But seriously. I've been told over and over again (by women) that their feelings are their truth. I've also observed many times that they tend to expect everyone else to treat their feelings as a priority and rarely seem interested in taking responsibility for managing those feelings or taking initiative to behave in such a way as to get better outcomes.
How many run-ins with HR must a man have before he recognizes the pattern?
I'm not trying to be incendiary or run afoul of the rules here but from where I'm standing this is just blatantly, obviously what's going on.
The answer my friend
Is blowing in the wind
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