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 -
This seems like it would actually be the opposite of price transparency, at least from the perspective of consumers. Each item of healthcare would still have a price, but they would be totally and completely oblivious to it. It would be entirely up to bureaucrats to look through the prices and decide what procedures seem to be worth it.
Concerning (1), selection of a doctor is approximately as difficult as any other selection of a good or service. There are a variety of solutions other industries have used. Branding, reviews, spec sheets, etc. Compare your ENT to very similar services that don't get to play the "insurance made me do it" shell game, like lasik or cosmetic surgery. Since they have to actually convince you to pay a real sticker price, they're vastly more open about it. They usually have free consultations; they tell you on their website what cool expensive tech they use; if you're the type of person who wants to shop around, ask questions, and figure out who you're comfortable with, you can do it. Some people are still going to view it as, "Well, you just go, do the thing, and pay whatever price," but if you want to be more informed, you at least can. You can at least usually get them to not lie to you and say that it's impossible to know what the price will be.
Concerning (2), this is obviously a more difficult one. Let's scope out a bit and consider a comparison with a hypothetical ENT who doesn't have access to their own CT. My experience has been that with someone like this, they send you out with orders to get a CT from somewhere and have the results sent to them. But then, when you come back, usually, you don't pay for an "additional" visit. Instead, it's treated as an extension of the original visit, which needed to be interrupted because of the need for a test. There is a true tension here that is hard to resolve. For legacy reasons, we don't just pay doctors by the hour, we pay them by the service. If we paid them by the hour, it wouldn't matter whether we got the CT there or somewhere else; that doctor is still just spending the time of "make recommendation for CT + evaluate result of CT", and those things are just more or less stretched out across different days.
The fundamental thing happening here is some sort of bundling. Bundling often makes sense. I had a dental implant, and there were multiple visits. Several were just, "Let's follow-up in two weeks; I want to see how it's healing to make sure there aren't any issues." Every one of those was bundled with the price of the original service, not charged as an "additional visit". Honestly, I was naive at the time, didn't ask a lot of questions, and sort of didn't know that they were bundled until after the follow-up appointment was finished, asked if I needed to pay anything, and they said no. This sort of bundling makes tons of sense. Other times, people don't bundle. I got stitches for a cut one time, and when I went to get them taken out, I had no idea whether this <5min followup was going to be bundled or not. Turns out it wasn't. Honestly, if I had known that it wasn't bundled, I probably wouldn't have spent the money for them to use scissors for 10 seconds. Again, we can compare to lasik. I haven't had it yet, but I've looked at websites. They often publicly state that certain follow-ups are bundled, because that is valuable price information for consumers.
In any event, the extent to which a service is bundled/unbundled is also usually not transparent. Are you sure you'd have had to pay for an additional visit if you had the CT done elsewhere? Did you ask? I'm not 100% against the idea that they might want to essentially give you a discount on the evaluation of the CT if you have them do the CT, but I want them to have to tell you this explicitly. "If you get the CT done here, we will bundle the price of the next step where we evaluate the result of the CT and decide what to do next. Alternatively, if you get a CT done somewhere else, we will not bundle it, and you'll have to pay extra for that." Most critically, I think this should not be a pressure tactic. It shouldn't be, "If you just sign on the dotted line RIGHT NOW, we'll give you a GREAT DEAL on this
new carCT follow-up!" Like, if they're bundling, they're probably not bundling strictly based on things happening right now. What if it's the end of the day; the guy in the office who actually runs the CT machine is about to go home; maybe it'll be better if you come back in the morning; "we'll do the CT first thing and then evaluate the results immediately after". Do they still bundle the follow-up? I'm guessing probably. So, there shouldn't be any difference between that and if you go home, shop around, then decide to have them still do the CT a few days later. If they're still going to bundle in this situation, I think we've gotten most of the benefits that we're going to get.So in sum on this point, I just want them to have to be more explicit about what is/isn't bundled. When they say, "We should do a CT; we can do it today," they should have to follow it up with, "Here is our price for a CT. That price includes the follow-up evaluation of the results. That price is good even if you shop around and then decide to have us do the same CT service tomorrow or next week. You can get a CT somewhere else if you want, but then we won't bundle the follow-up evaluation of the results, and it'll be an additional charge of $X." At least then, we can see what they're doing. We can see how their price is structured and make comparisons. It's still a bit anti-competitive to be integrated in this fashion and to have this type of preference for their own product. Honestly, anti-competition cases have been brought on less in other industries. I don't even think we need to get there now. Just get the prices and what is/isn't included out there in the open. Then, when people actually see what's happening under the hood, when they're actually seeing what games are played where and what things cost, they can decide which games they're willing to play and which prices they're willing to pay.
Finally, I also agree that true emergencies are tough. Sometimes, health situations naturally create their own pressure tactic. I don't have great solutions for this. I also think that true, really time-critical emergencies are far far more rare than most people think. Probably more than 90% of healthcare transactions simply won't matter that much if it waits a day or even a week. Don't stop us from putting good rules in place to improve the 90% just because those rules may not help the small minority. Even if we just exempt the small minority from the rules, we've made nothing worse (the small minority is in the same situation it was before), and we've made the 90% better. That's a pareto improvement.
But I do think that they should still have to be transparent if it's possible. Yeah, some people might take a risk in going to another hospital, hoping the stitches hold. Some people might even get burned by their choice (that's the nature of risk). Maybe they'd have needed the extra surgery a few days later at the first place, too. Lots of ways it could play out. I'm not saying my solution makes literally 100% of situations/choices turn out 100% optimal and that there is never a case where something bad/expensive happens. Literally no solution can accomplish that; again, that's the nature of risk. But I would rather be informed of the price and be able to make my own choices concerning my personal risk tolerance than not. Maybe the difference is $60, so I don't think the risk is worth it. Maybe the difference is $600, and I'm indifferent. Maybe the difference is $6000, and I think the risk is worth it. Someone else may be really risk averse and still pay the extra $6k. Yet someone else may estimate the risk differently and want to save the $600. Which of us made bad choices? Which of us got burned? Which of us came out ahead? Nature decides that, and no policy that either of us comes up with can possibly guarantee that no one will ever get burned. I just want people to be able to have the information and be able to make their own choice.
More options
Context Copy link