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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.
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.
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.
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?
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.
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.
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