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PaperclipPerfector  2d ago (text post)   9655 thread views

Culture War Roundup for the week of November 17, 2025

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To steel-man the idea that "knowing the cost" is always possible, I'm not sure it'd be reasonable to expect my (car) mechanic to define payment terms for a fix before even popping the hood. There are enough potential complications in complex procedures (emergency cesarean sections in childbirth, for example) that probably can't be trivially bundled up front.

That said, most of those cases are ones that don't really seem like they get much benefit from market-based economics either. But presumably somebody has to shoulder the cost of the not-completely-expected procedures that are found to be necessary: I'm actually somewhat sympathetic to the idea of single payer for this specific sort of thing, but haven't thought through all the bounds I'd apply there.

In India it is possible to know the cost. The hospital knows that some procedures have complications and prices that in. If the 4/5 patients cost 75k and 1/5 costs 2 lakh, they charge all of them a flat 1 lakh. You pay 1 lakh before the procedure and your obligation is done.

This is possible. The US having a different situation is a choice the US made.

That's just insurance socialism with extra fewer steps, right? The American public would never accept it. "Why should I, with my beautiful fast clotting blood and strong infection resistance, pay more for a procedure that will barely keep me in a bed for one night?"

To steel-man the idea that "knowing the cost" is always possible, I'm not sure it'd be reasonable to expect my (car) mechanic to define payment terms for a fix before even popping the hood. There are enough potential complications in complex procedures (emergency cesarean sections in childbirth, for example) that probably can't be trivially bundled up front.

The question isn't really do we know the cost, it is who carries the risk that the cost turns out to be higher (or lower) than expected. There are lots of situations where we are unsure about the cost going into a transaction, and the risk has to be distributed. Right now we operate on the system that the Hospital takes on only the risk that they don't get paid, while an "honest" patient takes on all the risk. We could quite easily choose to distribute that risk differently.

I know healthcare is complex, much more so than wrenching, but the idea that we don't know how to price things isn't true. There are codes for all this stuff, there's plenty of data on what a procedure involves (in terms of consumables/times/equipment) that can be used to blend it.

Any healthcare provider already does all of this for P&L reporting, care plans, etc. but they have to hide what they know to negotiate with insurers and the government.

but they have to hide what they know to negotiate with insurers and the government.

They don't have to hide the terms of the agreement that they signed with said insurers. The insurers already have this! They both signed the agreement!

Sure, they can continue hiding their internal costs, but those were never something that the patient cared about anyway. The patient cares about what they're going to get billed, which is a number in an agreement that both the provider and the insurance company have.

In the auto mechanic example, this is like saying that the shop owner hides how he compensates his employees, pays for consumables/times/equipment/etc. That's all perfectly fine. I don't care to know that. Just tell me what number you're planning on putting on my bill.

You're misunderstanding. The medical complex knows how much treatment costs, what margins are, all of it.

An insurer - if they had that information - would use it for more leverage when negotiating their payment agreements. They can put together something like it when they're big enough to compare costs across multiple systems, but that's about it.

You're misunderstanding. No one is asking for their internal treatment costs/margins/etc. They keep that hidden. Then they sign an agreement. That agreement has numbers in it. Different numbers from their internal treatment costs/margins/etc. Those numbers are known to both parties. They both signed a document with those numbers in it! They are not keeping those numbers hidden. Those numbers are the ones that they can give to patients.

Yeah seems like we're talking past each other here. I'm not disputing that at all. There's not a good reason to hide these costs from consumers.

Typically, with the car mechanic, the deal is that you agree on a certain amount for diagnosing, and perhaps give them a certain budget for fixing stuff. If things get more expensive, they call you so you can make an informed decision.

Also, I do not see the benefit of making people pay the actual costs of their procedure instead of the expected costs as estimated beforehand.

So, if you want to find a hospital to give birth, different hospitals could make you offers based on your health conditions and date. If they estimate that there is a 10% probability that you will need an emergency C-section, they can just add 10% of the cost of one to the offer.

This would also align incentives way better, because the hospital would only do emergency C-sections if otherwise they would run into malpractice territory. By contrast, if the hospital can just bill the additional costs to the patient, their incentives are to to an 'emergency' C-section at the first sign of troubles and then make the poor schmuck pay for it. 99% of patients will not litigate the overenthusiastic indication, and the ones that do will be dirt cheap to settle because apart from the costs of the operation, there is little in the way of damages. A scar over your abdomen might be worth a few thousand dollars, but that is basically nothing compared to a child which was oxygen deprived during birth.

Indeed, HVAC works the same way- there's an NTE amount, you have $1k(or something) to find or fix the problem. If the labor and parts amount to more than that you submit a quote. If the quote is wrong you submit another one(and the customer is very irritated, but commercial HVAC techs Are Not Known For Their Customer Service anyways). Either way, customers have an approximation.

Now the human body is more complex than air conditioners but it seems like doctors could do the same thing?

This seems like one of the better ways of handling it, although it does demand that healthcare providers become sufficiently actuarially competent to properly forecast costs as part of their operations: maybe not great for small-time practices at a time when lots are getting bought up by larger networks as it is. For better or worse, many hospitals already have to do things like that to handle EMTALA and the fact that they can't actually expect all their patients to, you know, pay.

At my job, we write quotes by... giving a list of parts and the amount of time it'll take to install them to an admin, who tabulates the total cost. Healthcare's many problems do not include a shortage of admins.

Yeah but this stuff always runs into the brick wall of chronic conditions and lifetime disability. Even in a universe where disability cover was confined to just exceedingly obvious issues the costs can snowball ridiculously

I would be over the moon thrilled if doctors were as transparent as auto mechanics. They tell you what they're planning on doing, they give you a (usually pretty good) estimated price, and then if they get in there and find something that's going to change their plan/cost, they tell you, give a revised estimate, and get your approval before proceeding.

No one is asking for doctors to be clairvoyant. Just that they do basic communication of what they know, when they know, to whatever extent possible.

Obviously, there could be cases where a patient is under anesthesia, they find something genuinely unexpected, whatever. I think a simple rule for this is to just follow normal informed consent principles. If you'd be comfortable proceeding without getting specific informed consent for the medical costs/benefits, then you probably don't need to give them a price, either. But to use an example based on what one of the doctors here said before, he said that they might know that a surgery typically costs $X, but 1% of the time there's a thing that makes it cost $[Stupid]x[X]. Simple: you know this, so just communicate it to the patient. Sure, it's probably not going to change much in that particular case, but at least they've gotten a heads up that there's about a 1% chance that they'll wake up on the hook for their entire OOPM. [EDIT: I'm pretty sure this is concordant with medical informed consent procedures. If you know there's a 1% chance that there will be a major shift in what you're going to do in a surgery, I'm pretty sure you're kinda supposed to tell the patient, "Hey, so this is a small chance, but it is known to be about a 1% chance."]

It's honestly just basic human decency in business practice.

If you know the rate of the complication and the cost change then a simple financial insurance product could normalize that cost.

Yes, but your car mechanic won't rebuild your transmission without letting you know that it's not covered by your insurance.

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