This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
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.
It’s one of the worst things about this country.
Not knowing the cost should be illegal.
Tear down the entire economy to cull the health insurance industry - it’s one of many things, but imo the most important, that needs to be ripped apart and changed in a manner beneficial to most Americans.
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.
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?
More options
Context Copy link
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.
More options
Context Copy link
More options
Context Copy link
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
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link