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ControlsFreak
1d ago
I read the article as criticizing both the provider and the insurance company, rightfully. They never once put the blame for "dropping the ball" solely on one party or the other. I don't either. Both parts of the industry need to get over the ridiculous idea that prices don't matter to patients and do better at informing them prior to decisions. It is mostly the gestalt sense that prices don't matter and that there's no point in informing patients that causes both of these players to fail so miserably.
It is unfortunate that the author didn't tell us much more about UHC's perspective on the matter. That might have given some choice quotes to make my point further that they're not getting it, either. But we did get choice quotes from MSK which very clearly and directly make my point.
Throwaway05
1d ago
I mean I think the article is accidentally a great example - they didn't actually need to know and numbers, it got covered, no?
They did end up running around sweating because the insurance company decided to be an asshole, which is what they do. Physicians complain about prior auth abuse all the time, and United is one of the worst. Basically they just try and refuse enough and slow things down enough that at times patients and doctors will give up and go with sub optimal management.
Quality price transparency doesn't help in those sort of situations and will likely help insurance company's beat on health systems.
It's also extremely expensive, you'd have to hire a lot more staff, and since people always expect physicians to know these things you'd probably have to cut clinical supply.
You could certainly change the system via regulation but that has its own costs and there are easier targets to reduce patient angst like prior auth reform.
For a more paternalistic and therefore likely less popular take - the system is incredibly complicated and even people who are subject matter experts in it get shit wrong quite a bit. Injecting patients into the mix would just add to the confusion, expense, and angst.
fmac
Ask me about bike lanes
1d ago
Does Rimworld have curated mod packs a la Wabbajack for Skyrim? My patience to manage mods has a strongly inverse correlation with my age lol
fmac
Ask me about bike lanes
1d ago
Definitely play vanilla first just so you get a sense of what the game is like, just enough that you can win fights against evenly matched up fleets up until mid-game so you don't suck and don't get overwhelmed
Then get into mods and it'll be less overwhelming
I hate vanilla purists though, I recommend getting QoL and UI mods immediately
quiet_NaN
1d ago
The UK's claim to a slice of Antarctica is worth about as much as if they claimed a crater of the moon instead.
Nobody wants to live in Antarctica. I would rather raise kids on a container ship.
This means that the normal process of the rule-based international order, where local polities organize however they like and get recognized as states (which is already flimsy in the case of Greenland with its 0.028 persons per square kilometer) will not have a good solution to this.
The traditional solution to solve conflicting territorial claims is, of course, war. Happily, Antarctica, being south of the Tropic of Cancer, is far outside NATO territory. So if the Brits want to wage war against China or Argentina in some god-forsaken desert of ice and desolation, let them.
Alternatively, the nations of Earth might jointly decide to exploit the resources of Antarctica, but in that case I would expect a reshuffling of territories. China is not going to accept that it does not get a slice based on some claims frozen by a treaty 60 years ago. Nor is the US, certainly not under 47.
fmac
Ask me about bike lanes
1d ago
Genuinely I have no idea
I'm willing to be the first to cooperate vs defect as I believe in the power of human win/win coordination
But I am a single human with 0 political power
Honestly I'm mildly a doomer about all of this, I just refuse to say "fuck it" and embrace the zero sum game
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
I have played Starsector, but only in the most technical sense. I booted it up once, did 5 minutes of the tutorial and then got sidetracked. Surprisingly, the reason I tried it was because I saw that mod you mentioned in an overview video, and wanted to learn the ropes before diving into the modded experience. I'll try and get back into it for good!
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
I never seem to enjoy video games while high on weed. Drunk? Loads of fun. While my stimulants haven't worn off? Hell yeah, I'm absolutely going to out-camp that sniper.
I find a lot of Arma boring myself, and I do have ADHD. I enjoyed Zeus because there's always something to do. Are the players getting complacent? Arrange for an ambush. Put on mood music. Start setting up an objective while they're cleaning up the last one. Eavesdrop on conversations, which is great fun because that British unit had some funny MFs in it. In contrast, while I do like the PvP, I would definitely prefer less driving between objectives or long hikes.
By all means, you must give Rimworld a go. Play one game of vanilla, or maybe three, note all the major annoyances, and then go hunting for mods to fix it. I probably get more enjoyment out of "hey, that mod looks cool" than actually playing the game lol, especially with how things break once you have too many. Can't blame them, when I've had 500+ mods running at once.
ControlsFreak
1d ago
I agree that there are plenty of situations where the patient doesn't really have much skin in the game or where price mostly doesn't matter for whatever reason. I wrote about an example of the former here.
The latter are probably quite routine, too. This is sort of unsurprising in economics. Demand curves slope downward, and everyone to the left of the equilibrium point gets consumer surplus. The further left you go, the more surplus they get. If I'm a customer who would buy an apple for $2, and prices usually vary a bit around $1, but maybe if there's a bad harvest, they're like $1.50, then yeah, for the most part, the price doesn't matter to me. That doesn't really imply that the price doesn't matter in general. So, riffing of what you say:
Price transparency is nice for society, but not crucial for patients.
Price transparency of apples is not crucial for a bunch of people whose willingness to pay isn't somewhat close to what the price actually is. But it's actually pretty important for society and for a bunch of people whose willingness to pay is much closer to the actual price.
Many people are discovering the headline-grabbing version of the problem, too. Imagine if apples usually cost about a dollar. It varied from day to day, but they didn't tell you up front. Some times, incomprehensibly to the individual, they suddenly cost $1k. But they also didn't tell you this until after you'd eaten it (after services were rendered). Everyone knows it's kind of sketch, but no one can bring themselves to just make the grocery stores give people a price up front. This is how a lot of people view the current lack of transparency. Memes abound about how you got a papercut, spun the roulette wheel of the American Medical Industry, and found out later whether it cost you $1 or $100k.
Secondly, the health insurer and the hospital already have a pre-existing agreement on a price list. What they are negotiating about is which medical procedures (and line items) are indicated.
Yup. This cuts out most of the arguments for why patients shouldn't get prices. At the very least, providers can provide an estimate of what procedures (and line items) they're planning to bill. They can look at the pre-existing, agreed upon price list, that they have, and give you the relevant information. Of course there will be cases where 'something happens', and it turns out to not be correct. The classic example is that you're going in for a relatively routine surgery, and there's like a 1% chance they're going to find something that 100x's the price. Well guess what? There's a good chance that the doctor already told the patient that there was something like a 1% chance of finding something that significantly changed the nature of the procedure. That's just good informed consent. That same informed consent should at least include some form of, "...and yeah, if that happens, it'll 100x the price." (Now, that may not meaningfully matter for some insurance cases, but just inform them, people!)
For the most part, providers and insurance know where the line items are that typically get argued over. Sometimes, a pre-auth is actually good to do. Providers can at least tell the patient what their plan is, but it would also be nice if they gave their perspective on whether the planned billing was likely to run into difficulties or not. As the linked article puts it:
Given that presurgery mental health is surely part of the institution’s concern, it could have sent out a note saying: “Hey, you’re about to get a scarygram. Don’t worry, we’ve got you. Here’s why.”
Just communicate. If there's likely to be some sort of issues with haggling over line items, inform your patient the best you can.
confidentcrescent
1d ago
Based on the linked article I read, the couple was unsure about going forward with the surgery because it was unclear how much of the bill their insurance would cover. They got surprised with this last minute because their insurance dropped the ball.
None of the problems in this article are described as being caused by the healthcare provider and the author himself seems to think that these problems were at best only tangentially MSK's responsibility, including the following right after his criticism of them:
That said, MSK, like my wife and me, was downstream of UnitedHealthcare’s prior authorization system. The insurance company was the decider here, which puts the responsibility for quick and clear communication primarily on UnitedHealthcare.
Despite this, you spent most of your comment about prices in healthcare talking about doctors and providers. Why? How was this your takeaway from an article which almost entirely blames the insurance company?
Jiro
1d ago
Would much prefer an unwinding of the political cold war
And exactly how are you going to do that?
Jiro
1d ago
If people won't and can't use the prices, how exactly do we get the situation in the OP where the NYT writers specifically wanted and could have used price information?
Lazuli
1d ago
I understand a few people on this site really abhorred RF Kuang's 2023 novel Yellowface.
The book is way more enjoyable if you ignore Kuang's seething and take the satire at -- pardon the pun -- face value.
IGI-111
God was a dream of good government.
1d ago
I guess Lucas should have listened to the suits instead of his nerd buddies and ditched his pulp space opera idea. Audiences won't connect with it. And even if it was produced they would only give him the toy rights.
fmac
Ask me about bike lanes
1d ago
Kind of?
Until you're both way worse off at the end of it all. Although I guess you're both worse off together.
Would much prefer an unwinding of the political cold war and a commitment towards shared prosperity (as that's worked quite well for the last 10,000 years) but that brings us back to "the current crop of western political leaders are myopic morons"
roystgnr
1d ago
once it's established that the symbolism of magic = family love is all that matters, the backstory revelations undermine it: Was it grandpa's death that brought about family love?
... Yes?
He's leading refugees away from their burning village, he sees soldiers catching up to them on horseback, and he kisses his wife and babies goodbye to turn back and (checks video) wave down the soldiers. Rather than using the opportunity to run or hide, his wife stops in her tracks to watch him die. The natural interpretation here is "he loved them so much that he would run to his own death just to buy them another minute to run and hide, and she loved him so much that even in those circumstances she couldn't bear to leave him, and The Magic rewarded such powerful love." (The other interpretation, "neither of them had the common sense or tactical acumen of a mouse, and The Magic took pity on such powerful stupidity", doesn't really fit the movie's tone.)
fmac
Ask me about bike lanes
1d ago
You may like Starsector.
It's basically "mount and blade in space" but with an incredibly well designed and tight gameplay loop for the 2D ship to ship combat.
The mod scene is also exceptional (Nexerilin is basically a DLC that massively improves the game by making it a 4x-lite). Although filled with unbelievable amounts of discord drama (totally ignorable, but hilarious).
Your allied ship AI is quite stupid, but my god it's so fun to space battle.
You can also get a free CD key from the Sseth review video (meme-y video game review channel) if you want to try it, developer approved as he's a very chill guy.
fmac
Ask me about bike lanes
1d ago
Factorio is really fun but you basically are forced to restart a few times because it's easier to start from scratch than it is to totally refactor your mineral bus once you've spaghetti-maxxed
It'll probably click for you and delete a few weeks though, it's incredibly compelling, the factory must grow.
I usually start getting burnt out from the complexity around oil, and I tried playing a while ago with a new update, played for a while (got to oil), and then saw the tech/production tree for nuclear and promptly quit and uninstalled the game. Started to feel like I was studying or working to play the game.
A brief tangent on medical billing that US-based Mottizens may find useful.
So back in college I worked for an insurance company for a short amount of time. While there I received a crash course in medical billing, and what I learned ended up being pretty helpful in disputing a bill I received a few years later. All doctor's offices, hospitals, and clinics across the country (the US) use a standardized billing method. While the actual paper bill may look different, each and every one will provide you with a list of common codes for the services you received. These are called Current Procedural Terminology Codes, or CPT Codes. These codes are published by the American Medical Association (AMA) and get very, very, granular. When you receive a bill, it is to your benefit to look up these five-digit codes to make sure that they match the treatment you received. Hospitals have a perverse incentive to "upcode" your bill, that is to put down a code for a higher tier/cost, of treatment that you received. This is illegal, but it happens with shocking regularity.
Consider code 97161, "pt eval low complex 20 min." That is, a healthcare provider spent between 0 and 20 minutes in the room with the patient, providing an evaluation of a low complexity issue. An unethical hospital might "upcode" this to 97163, "pt eval high complex 45 min." Or you might have gone in for a G2251, "brief chkin, 5-10, non-e/m." That is a brief check-in for 5-10 minutes for a non-emergency issue, which might get up-coded to a 97161.
You will rarely, if ever, know the exact proper code for what you went in for. You're not supposed to. This is arcane back-end stuff the patient is not supposed to ever really understand. But the list is public information, and you can very easily check the codes you were billed against the list of treatments. Being able to respond to a bill with specific questions, such as "why was I billed for an hour-long patient interaction when the doctor was only in the room for 20 minutes?" is a very effective way of disputing a medical bill.
fmac
Ask me about bike lanes
1d ago
I've definitely been alpha-widowed by my favorite games, lol
fmac
Ask me about bike lanes
1d ago
We have pretty similar taste in games, although I find ARMA way too boring and love battlefield (as much as they keep insisting on fucking it up).
I too bounce off games really hard, and I basically only enjoy gaming now if I also take cannabis, otherwise it's kind of boring and I stop after 45 mins.
I had the exact same experience with BG3, I feel like I should love it, but I just kinda... stopped.
I tried getting back into modded Skyrim after learning Wabbajack existed (I don't have the patience to manage massive mod lists) and it was INCREDIBLE but again after getting not that far into a run, I just... drifted away
I really want to get into Rimworld and Total war (played Shogun a bit, then stopped) but haven't gotten around to it (lol)
I basically just play heavily modded civ5 (seriously vox populi is insanely good) and Victoria 3, I don't even find either of those games super duper fun anymore as I've played them a lot, but I always end up back on them instead of diving into something new.
Same, except the game came out when I was in college and your post made me feel old. But like you, I tried playing WoW classic and it just wasn't the same. The game was (mostly) the same of course, but my frame of reference was different and it had a much different feel as a result. I ultimately didn't stick with it, though I did have fun for a while (and my wife said I was "bellowing with joy" when I got my first green drop in Elwynn Forest, lol).
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