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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.
I'd really rather stay focused, because you made a very specific claim, and whether or not healthcare "functions as a market" is not even relevant to it. Literal socialized industries (including healthcare in other countries) are able to give you the price of a particular product / service, so even if American healthcare is somehow not a market, it still should be able to the patients information about the prices of it's services.
My claim was that the price, charge, and cost are all highly different from each other, often have minimal relationship to each other, have little value to the patient, and are highly misleading and hard to understand.
You noted "but I don't see how this is any different from any other industry that faces uncertainty (which is all of them)."
Well yes healthcare is different. That's important. It's inherently obvious in many ways. One of those is that "price, charge, and cost are all highly different..." the other is the problem with the supply and demand curves, the level of governmental intervention...... I provided several examples.
Furthermore -
Two posters in this thread neatly outlined the problem with what you are talking about.
If you charge people for what they use and only what they use and try and give them an answer in advance they get pissed when their hot dog costs 1 million dollars instead of 5.
If you add up the total costs of the ED and do some math to throw out the people who won't or can't pay and then charge people something that more resembles the true cost of the service on a per capita basis they then come on the motte and complain that they sat in a busy ED for 6 hours and got an ultrasound and it costs them how many thousands of dollars? (Sorry dev, but it's a good example).
Ugh we are back to healthcare doesn't function like anything else.
Few if any other lines of business are required by law to provide services to someone who walks in and says they will refuse to pay. Add on the fact that sometimes but not always you can get it covered by the government and the accounting is ferociously hard.
Obviously you can generate numbers like total revenue but turning that into useful information at the patient level is an ethical and political problem long before it becomes a practical one.
The claim I was originally responding to:
The part I was questioning was about how hard it is to give the numbers, how hard it is to make them accurate, and how costly it would be. None of it was about how little value they have for the patient, or how difficult to understand they might be for them.
It's yet to be demonstrated in ways relevant to the question of the difficulty of providing patient with the price information.
You can argue that this is not what the average American wants, but you haven't shown that it's impossible to show them those numbers. I already told you that, and you never addressed it.
A simple ED visit can cost <5k, 50 thousand dollars, 1 million dollars, or 5 million dollars.
An estimate for your kitchen getting redone is not like this.
The error bars around those are secondary to the fact that when people want an estimate in their mind that estimate is a commitment and being told a range from 500 dollars to 5 million is worthless information.
Yes plenty of healthcare interactions are simpler than that but if you are going to demand estimates for everything you have to capture this problem, if you are going to demand estimates when feasible we already do that.
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