5 ms·

You make some good points regarding quality, but there are a great many things where that doesn't matter. Yes if it's a major medical issue where a life hangs

You make some good points regarding quality, but there are a great many things where that doesn't matter. Yes if it's a major medical issue where a life hangs in the balance quality matters tremendously. But a huge range of medical care is about quality of life or other more minor things. I also think that if prices were available to people they might choose the preventative care themselves versus waiting until things are so bad that a major and costly intervention is needed. People talk about externalities as if they're the devil when it comes to climate change, but when it comes to medicine nobody bats an eye. Right now the consequences of people smoking, eating poorly, drinking too much, etc are generally externalities for individuals because either their insurance eats the cost or the public does. I'm not suggesting that people should be forced to bear that cost entirely on their own without insurance, but with no pricing available GPs have one less tool to "scare straight" their patients. I think what's especially galling is that the hospitals do have all the pricing information available in a database that they use to turn patients charts into bills. It's just not published publicly so patients can't make a slightly more informed decision on the front-end, they only see it AFTER care has been provided.

VLM 11y ago
> I also think that if prices were available to people they might choose the preventative care themselves versus waiting until things are so bad that a major and costly intervention is needed. Insert analogy with car maintenance here. I'm just not seeing it in practice given the car maint example, although it sounds nice. Clearly, based on the car example, you can't motivate people merely with $$$ or inconvenience or some responsibility guilt trip. I'm thinking pain might work. "The total pain experience of a root canal is Y% vs flossing at a total pain experience of Z% make your choice..." Then again people seem impervious to pain, or impervious to learning from pain. "lets have another kid" "lets go on a fifteen mile hike in brand new boots" "hold my beer and watch this" If $, inconvenience, and guilt trips don't work, and pain also fails, I'm not sure whats left as a possible motivator.
- msandford 11y ago
  Pain, cost, inconvenience, etc are all marginal motivators even if they don't have the 100% effect on people's behavior that you'd like. Some people are going to be dumb full stop. But for everyone else, giving them more information is probably going to be useful and on the whole, will move things in the right direction. Keep in mind that I said "might" not "definitely will for sure 100%" so that's in line with my above comments re on the margin.
  - VLM 11y ago
    I think our disagreement might fundamentally revolve around you seeing "might" and I'm observing "almost always does not". I'm still interested in the idea of listing and evaluating motivators, so we've listed four of varying opinions of effectiveness, it would be interesting to identify a fifth (or more) of equal or better effectiveness. Thinking of what PR people like to use, there's sex appeal, I suppose that could be used in public service TV commercials as a new fifth strategy. I have no idea how to sell "preventative EKGs are sexy", but I'm no marketing guy, and somehow they sell cars and junk food with sex appeal, so its probably possible to sell EKGs and immunizations and diabetic glucose test screens under the same strategy... somehow. This sounds like such a bad idea, I hesitate to declare it a serious fifth strategy idea.
    - msandford 11y ago
      Fair enough. I guess part of the appeal of having published prices is what other people could then do with them, too. Not just that I could shop around for rotator cuff surgery or a hip replacement, but actually interesting stuff that's only done internally right now. If prices were published then someone could track the prices of a great many procedures and look for procedures that were getting cheaper. You could then interview people at institutions that are able to do those procedures less expensively and publish it. Other institutions might then follow suit and the savings could be shared widely. The lessons might cross boundaries and spark other folks to recognize that X is very similar to Y and they can use the same lessons to make Y cheaper, easier, more foolproof, etc. Further, with reasonable pricing information and some measure of quality it would be pretty easy for people (and perhaps insurance companies) to encourage medical tourism of a great many varieties. Maybe the country doctor or dentist is very skilled but wanted the country lifestyle and doesn't want to drive 2 hours a day to the city. But perhaps city folks would be happy to drive to the country to enjoy a cheaper procedure, hospital stay, etc versus in the city. Right now this kind of arbitrage isn't possible again because prices aren't disseminated widely. Finally when we're talking about human lives which we think are intrinsically valuable and arguably priceless, then I'm not sure that "almost always does not" doesn't mean that something isn't valuable. Young people with families buy life insurance against something which "almost always does not" happen, namely their premature death and yet nobody argues that life insurance shouldn't be allowed. Similarly for any one individual wearing a seatbelt "almost always does not" do them any good since car accident rates are very low, at least on a percentage basis. http://www.forbes.com/sites/moneybuilder/2011/07/27/how-many-times-will-you-crash-your-car/ http://www.forbes.com/sites/moneybuilder/2011/07/27/how-many...

VLM 11y ago

> I also think that if prices were available to people they might choose the preventative care themselves versus waiting until things are so bad that a major and costly intervention is needed. Insert analogy with car maintenance here. I'm just not seeing it in practice given the car maint example, although it sounds nice. Clearly, based on the car example, you can't motivate people merely with $$$ or inconvenience or some responsibility guilt trip. I'm thinking pain might work. "The total pain experience of a root canal is Y% vs flossing at a total pain experience of Z% make your choice..." Then again people seem impervious to pain, or impervious to learning from pain. "lets have another kid" "lets go on a fifteen mile hike in brand new boots" "hold my beer and watch this" If $, inconvenience, and guilt trips don't work, and pain also fails, I'm not sure whats left as a possible motivator.

msandford 11y ago
Pain, cost, inconvenience, etc are all marginal motivators even if they don't have the 100% effect on people's behavior that you'd like. Some people are going to be dumb full stop. But for everyone else, giving them more information is probably going to be useful and on the whole, will move things in the right direction. Keep in mind that I said "might" not "definitely will for sure 100%" so that's in line with my above comments re on the margin.
- VLM 11y ago
  I think our disagreement might fundamentally revolve around you seeing "might" and I'm observing "almost always does not". I'm still interested in the idea of listing and evaluating motivators, so we've listed four of varying opinions of effectiveness, it would be interesting to identify a fifth (or more) of equal or better effectiveness. Thinking of what PR people like to use, there's sex appeal, I suppose that could be used in public service TV commercials as a new fifth strategy. I have no idea how to sell "preventative EKGs are sexy", but I'm no marketing guy, and somehow they sell cars and junk food with sex appeal, so its probably possible to sell EKGs and immunizations and diabetic glucose test screens under the same strategy... somehow. This sounds like such a bad idea, I hesitate to declare it a serious fifth strategy idea.
  - msandford 11y ago
    Fair enough. I guess part of the appeal of having published prices is what other people could then do with them, too. Not just that I could shop around for rotator cuff surgery or a hip replacement, but actually interesting stuff that's only done internally right now. If prices were published then someone could track the prices of a great many procedures and look for procedures that were getting cheaper. You could then interview people at institutions that are able to do those procedures less expensively and publish it. Other institutions might then follow suit and the savings could be shared widely. The lessons might cross boundaries and spark other folks to recognize that X is very similar to Y and they can use the same lessons to make Y cheaper, easier, more foolproof, etc. Further, with reasonable pricing information and some measure of quality it would be pretty easy for people (and perhaps insurance companies) to encourage medical tourism of a great many varieties. Maybe the country doctor or dentist is very skilled but wanted the country lifestyle and doesn't want to drive 2 hours a day to the city. But perhaps city folks would be happy to drive to the country to enjoy a cheaper procedure, hospital stay, etc versus in the city. Right now this kind of arbitrage isn't possible again because prices aren't disseminated widely. Finally when we're talking about human lives which we think are intrinsically valuable and arguably priceless, then I'm not sure that "almost always does not" doesn't mean that something isn't valuable. Young people with families buy life insurance against something which "almost always does not" happen, namely their premature death and yet nobody argues that life insurance shouldn't be allowed. Similarly for any one individual wearing a seatbelt "almost always does not" do them any good since car accident rates are very low, at least on a percentage basis. http://www.forbes.com/sites/moneybuilder/2011/07/27/how-many-times-will-you-crash-your-car/ http://www.forbes.com/sites/moneybuilder/2011/07/27/how-many...