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Quality Contributions to the Main Motte
Contributions for the week of July 28, 2025
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Contributions for the week of August 4, 2025
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Contributions for the week of August 11, 2025
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@ControlsFreak I was visiting the US with my girlfriend when she developed Lyme Disease. She'd forgotten to get travel health insurance. This is when we were fully hit by the absurdity of the American system.
Lyme Disease can lead to lifelong disability if allowed to develop. Fortunately, it can be safely & fully treated with <$10 worth of antibiotics. We knew that she had it, we knew how to treat it, we just had to find some doctor that would give us a permission slip to buy the medication.
We visited or called a number of walk-in clinics. All were members only (???). We called urgent care and could not obtain even an upper bound on how much a dx + rx would cost. Hundreds? Thousands? Who knows lol.
We seriously lucked out in the end. We stopped at a gym to shower and the lady at the front told us of a clinic run by an ex-marine PA in the back of the local grocery store. $60 in and out. We got to see his drone videos of the Olympic coast. If you're ever sick or injured near Forks WA you will find no one better than Jonas Merrill at the Beaver Clinic.
Note that an upper bound is an extremely difficult question.
If you worked with a realtor and said you wanted to buy a house but didn't know yet where you'd be buying and what your requirements were...the only reasonable answer to the upper bound is whatever the most expensive house ever sold is. An urgent care has some maximum limitation on available services (in comparison with an ED) but the situation is fundamentally somewhat similar. That number would be functionally useless.
"What will you most likely charge me as the cash price for a basic office visit" is something a PCP can easily do and generally do when they are allowed to do so.
However as this is America many places will prohibit providing this type of information as a matter of policy because of the risks associated with doing so (like being sued if the bill is higher than the estimated number). This is a general side effect of corporatized medicine as decisions are made by large inflexible organizations with massive legal and compliance departments and clinical and office staff with no independence and authority.
As you saw independent practitioners may still use common sense,* but they are being forced out of the market by things like increased regulatory burden.
This is what had me so incensed the first time this came up - individual requests like "provide prices" "you need an EMR" "have an HR department" have become so burdensome and accumulated in such numbers that private practice increasingly no longer makes sense and therefor flexibility is gone.
*And some types of interactions like this are strictly speaking illegal/fraud.
Cite one example of a provider being sued because a bill was higher than an estimate. Do you think this commonly happens in other industries which provide estimates, even though the final bill might end up higher? (E.g., auto mechanics, plumbers, etc.) Fake "liability concerns" is a common excuse for shady practices in a variety of industries. In fact, it's funny that you bring up realtors, because they definitely bring up fake "liability concerns" for all sorts of shady practices.
It's actually extra funny, because realtors did just last year have a huge, billion dollar lawsuit because of their attempts to hide prices. It resulted in industry-wide practice changes, the largest of which is that they now give people prices up front, in writing.
I'm 99% sure that I've had work dropped from my bills because they wanted to stick to their estimate more than they wanted to charge for their actual efforts. This could be due to simple integrity or good customer service, but it could also be a legal strategy to avoid liability.
Heck, even the risk of being sued unsuccessfully by an irate customer might outweigh the value they get from attracting customers like OP.
That some providers sometimes drop some charges is pretty irrelevant to either the question of whether there is any meaningful legal risk to providing price estimates or the question of whether it is socially good for them to do so. If, as the good doctor says, there has never actually been a case of a patient suing a provider because an estimate didn't match the ultimate bill, then the liability concern is fake. It's fake even if they sometimes drop some charges because of their fake worry for a fake concern. Honestly, I can't even see what legal theory one would try, because it's so incredibly easy and obvious how to make estimates in a way that doesn't produce any legal liability. Basically every other industry that has estimates does it just fine.
Just a heads up, though, this is just part of the gish gallop. There are seventeen other fake reasons doctors give for why they can't provide prices. And frankly, just like with a Holocaust denier, you can spend your time focusing on one or two of them, really showing that they're totally fake, and then they'll just shift to some of the other ones for the next week or so, and in two weeks, these ones will pop right back up, as if nothing was ever said on them.
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Yes exactly, I don't know of any cases where a patient has sued over a bad estimate, but I do know plenty of cases where a patient had an estimate that was labeled as such and then refused to pay the bill when the estimate was...an estimate. Puts the hospital in an awkward spot and I do know of many cases where the hospital chose to take the PR hit and sued patients to attempt to force them to pay their bill (it is possible some of those generated counter lawsuits?).
Additionally the hospital does all kinds of crazy nonsense to prevent theoretical lawsuits, often the staff is the victim. I do a fuckton of modules every year that likely do nothing to reduce hospital liability but they are just crossing their fingers and making staff do this shit. Also the classic cases of a heroin addict being told "don't leave, if you do you have a high chance of dying" "no thanks I'm going to get high" and then some poor resident being forced to chase them down to convince them to sign an AMA form which has no value at all.
Lastly you have malpractice lawsuits, which illustrate that you can generate multiple hundreds of millions in verdict with no particular malpractice performed, or somehow be held liable even though you were completely uninvolved. Meddit is littered with these cases.*
After that abuse it's not shocking that people in medicine are skittish as hell.
*To be clear wrong does occur on occasion but supposedly the research shows that actual wrong doing is statistically unrelated to judgements/verdicts.
Ok, so it is a totally fake "liability concern", and to your knowledge, no patient has ever sued a provider over a bad estimate. Care to weigh in on whether you think this commonly happens in other industries where providing estimates is routine?
You're sort of running out of excuses to not provide prices if you're all the way down the list to fake "liability concerns".
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