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Whelp, I just got screwed again by the lack of price transparency in the American Healthcare System. feelsbad.man.jpg
Thankfully, it's not a huge dollar figure, but it's the sheer stupidity of clinging to price opacity, which inevitably finds some way to reach into my pocket and pull out more money, that annoys me.
It was not a situation where the provider didn't have the necessary information to understand why the price ended up being what it was. When I called them to ask WTH, it took all of three minutes for them to just go through the steps of verifying the process and then explaining it to me. But that's three minutes that they should have spent going through the steps in order to give me a price before they performed the service, rather than blindsiding me with a bill after the fact.
Yes, yes, I know, they don't want to spend three minutes per patient; that adds up! And of course they don't want to; it's not only their time being spent; it's not in any way in their favor to spend those three minutes. It's my pocket that it comes out of, after all.
Moreover, it was a situation where, had they spent the three minutes and we could have then had a conversation about the price, in hindsight, I am extremely confident about how I would have made a different choice as to the way that I arranged the services that I would have liked to acquire. I literally, actually, could have personally made a different choice if I had had price information, and it's a choice that I would have preferred in terms of my personal cost/benefit analysis.
Of course, it must be remarked on that had I had this information and had I made the choice that I would have preferred, the provider would have made slightly less money. I don't think they were doing this on purpose; it's just convenient for them to not spend three minutes and also probably make more money. They just have near zero incentive to even consider doing things in a way that may be in my own interest. The only danger that they run is that if folks like me eventually get pissed off enough at these shenanigans, we'll either search desperately for a different provider who will bother spending three minutes or simply get so fed up with the constant nonsense that we just eschew that sort of service altogether. Man, it's tempting to do that, because it's just... so... constant a problem. I'm already pretty cynical for how they're going to find a way to screw me over, and apparently even that was not enough cynicism.
The snafu did, in a minor way, relate to the way the insurance policy is written. I mention this only because I would like to hold open at least some amount of plausible blame for them (it's really kind of hard to in this particular situation, but I'll mention it anyway), but the provider legitimately had 100% of the information necessary to provide me an actual price and discuss tradeoffs/courses of action prior to services being rendered. They just didn't bother.
This feeling really makes me sympathize with all the people who are so outraged. I'm sure there are tons and tons of stories where the insurance company is more to blame, too, so I sympathize with those folks feeling gut anger at them, too. It's just monumentally infuriating to have them over and over again find endless ways to screw you over and see that it's not even malevolence. It's pure apathy toward your interests as a patient combined with an addiction to doing everything possible to remain price opaque.
This clearly wasn’t an ER/ambulatory emergency I’m guessing, since it’s a little difficult to haggle over pricing or consult the HealthGrades rating when you’re in the midst of a heart attack…
It’s just another reminder though that healthcare in the US is a business. The psychology behind the price point becomes irrelevant in almost all high risk occurrences when the choice is pay whatever X is in terms or cost or die on the other hand. If it’s just a routine check-up, this becomes much more debatable.
To your last point about insurance. I read an interesting paper that a hedge fund credit analyst once sent me of the breakdown behind a lot of the activist/propaganda economics people throw around about the industry. As it turns out, healthcare insurance when totaled amounts to only a 1.1% profitability margin (meaning most healthcare premiums actually go directly to costs). All the regulatory red tape also obscures price signals tremendously. There’s a lot of bad ethics that sits behind the industry as a whole, but it’s also a massive challenge trying to genuinely determine what the price truly is.
It's not about just health insurance, it is about financers and monopolists who own the insurance companies, the hospitals, and their supply chains. (Also a nitpick: the health insurance industry average profit margin in 2020 was 3%.) 34% of health care costs go to pay administrators, so a lot of it is having armies of staff disputing every charge at the insurance company, who in turn pays the hospital to have armies of staff fighting the disputed charges. Insurance companies also can have shared ownership with the hospitals that they pay, as well as with the PBMs and pharmacies where prescription medication is dispensed, and investors can even own the land the hospital is sitting on and rent it back to the hospital at unsustainable rates. Even the suppliers of online after-visit surveys are doing very well indeed. So all along the chain it is monopolies extracting value from the insurance companies, hospitals, and patient, along with a lot of coordinated greasing of palms and inside dealing.
Which is not to mention that the hospital prices are set such that they can cover the costs imposed by freeloaders and insufficient insurance/medicare/medicaid reimbursement. It's the dystopia of Americans being happy to pay more for declining quality of service and inefficient systems, while all the profits go to financiers and all the costs go to the taxpayer/honest payer.
it's worth mentioning how much of the admin is just due to complying with the regulatory burden that comes from being in the health care industry. The typical way we try to control costs is by rolling out complex programs that require more detailed coding, data tracking, etc.
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