3 ms·

There's a balance to be struck, for sure, but cost transparency as an alternative to complete and total cost opacity is a move in the right direction. My daugh

by bmelton 11y ago

There's a balance to be struck, for sure, but cost transparency as an alternative to complete and total cost opacity is a move in the right direction. My daughter fell at lacrosse practice and hurt her wrist. We had an x-ray, which proved inconclusive with the swelling, another x-ray after the swelling subsided, which also resulted in an inconclusive result, followed by an MRI which indicated a bad sprain, for which we ended up getting a very cast-like splint. This is basically the same as what we thought from the initial x-ray, as even then the doctor was advocating for a splint in the absence of an obvious break. If costs were more apparent, we probably would have had an x-ray once, and then gone with the splint, but price opacity and insurance obfuscated the costs enough that we naively opted for the more diagnostic approach, which proved to cost a lot more than just having gone with the splint initially. As a developer, I'm inclined towards the "know what you're fixing before building patches" approach, so the diagnostic approach was logical to me, but had I known that the end result was basically the same either way, I could have saved myself the cost of an x-ray and MRI and just skipped to debugging.

VLM 11y ago
If you turned the tables on your "free market" anecdote, what is the market value of that ER doctor or radiologist as a software developer? I'm not even sure how to account for emotions, I'm pretty dispassionate about unit testing frameworks, but if my daughter might be crippled for life I'm fairly certain I wouldn't be a rational market participant. Its highly likely that your trying to practice medicine without a license holds the same market value as a doc trying to be a software dev, that being somewhere between 0 and a modest negative number. You could extend the analogy by taking printouts of the pricing plans for github(tm) and visual source safe(tm) and waving them in front of the er doc to ensure the er doc makes the wisest possible free market decision when selecting a source code repository. This is only a fair analogy if the ER doc knows absolutely nothing about software development other than if he gets the decision wrong his life will be ruined. As a somewhat more neutral analogy, waving prices for github vs VSS in front of my mother quite frankly holds negative value for all participants, its a Potemkin show that merely wastes labor hours. Pretending to provide a market where none can possibly exist is wasting labor time putting on a show. My mom has some skill in real estate law so she should be making decisions in her area of expertise, and software professionals should be making decisions in their areas of expertise. My mom does not walk up to random people on the street and insist they make life changing decisions in minutes about the right legal strategy to provide clear title to real estate or WTF exactly she did before she retired, "well in that county a title search costs $X but title insurance and hoping for the best costs $Y unless we take it to court then it costs $Z..." etc. See you can "make a market" in a campy going-thru-the-motions sense by having a semi-monopoly provider declaring an arbitrary list of prices on a chalkboard then calling that a free market. But making a functioning efficient market is a whole nother kettle of fish that requires a calm rational meeting of equal minds at a similar level of training and education to dispassionately trade interchangeable identical commodities, with the goal of all participants minimizing the spread between price and value. That's pretty much the opposite of good medical care.
- bmelton 11y ago
  I'm not really sure what your point is, so perhaps I missed something? Conflating a want for price transparency, so that I can spend rationally where that rationality can be logically exerted doesn't really seem to me a free market ideal as much as it is just common sense. There are many medical decisions made that aren't life or death, and in my admittedly anecdotal experience, that's been most of them. A great many medical demands are inelastic. When I lopped the (very) tip of my pinky finger off in an accident, it was nowhere near a dire enough injury to worry about the cost of repairs, but it did need stitches. Had there been a repair option, I might have opted for it, but only if the cost was reasonable. That said, we already know the market value of an ER doctor, or a radiologist; that's how we know what to pay them. It's not as though they're members of some secret cult of faceless men exacting arbitrary payments for their efforts. We know what it takes to pay them, and presumably, they could come up with an hourly cost for their labor plus materials if they so chose. It might take some practice, as estimation is hard, but basically every other service industry in the world is able to do it, so I can't imagine why the medical industry would be exempt. Regardless, sure, there are plenty of ailments that would hard to estimate, or meaningless to do so, but I don't see why that means nobody should try to do their jobs in a cost effective manner.
fluidcruft 11y ago
Indeed, hindsight does tend to clarify things significantly. Frankly, don't you think the better solution might have been to cue in on your doctor's hint that the additional testing wasn't needed? Maybe costs would have clarified things. Maybe cost isn't a meaningful proxy for medical judgment.
- bmelton 11y ago
  It's been some time, but if I'm recalling correctly, the doctor seemed in favor of the additional testing. Whether that was because he was genuinely concerned, scared of a malpractice suit from insufficient testing, or something else I'm not privy to, I wouldn't know. As I mentioned elsewhere, maybe cost isn't a meaningful proxy for medical judgement, but on relatively trivial matters like wrist sprains, minor cuts, etc., it may often be a good way to discriminate, assuming appropriate follow-up to ensure that the initial decision wasn't errantly done.

by bmelton 11y ago

VLM 11y ago

If you turned the tables on your "free market" anecdote, what is the market value of that ER doctor or radiologist as a software developer? I'm not even sure how to account for emotions, I'm pretty dispassionate about unit testing frameworks, but if my daughter might be crippled for life I'm fairly certain I wouldn't be a rational market participant. Its highly likely that your trying to practice medicine without a license holds the same market value as a doc trying to be a software dev, that being somewhere between 0 and a modest negative number. You could extend the analogy by taking printouts of the pricing plans for github(tm) and visual source safe(tm) and waving them in front of the er doc to ensure the er doc makes the wisest possible free market decision when selecting a source code repository. This is only a fair analogy if the ER doc knows absolutely nothing about software development other than if he gets the decision wrong his life will be ruined. As a somewhat more neutral analogy, waving prices for github vs VSS in front of my mother quite frankly holds negative value for all participants, its a Potemkin show that merely wastes labor hours. Pretending to provide a market where none can possibly exist is wasting labor time putting on a show. My mom has some skill in real estate law so she should be making decisions in her area of expertise, and software professionals should be making decisions in their areas of expertise. My mom does not walk up to random people on the street and insist they make life changing decisions in minutes about the right legal strategy to provide clear title to real estate or WTF exactly she did before she retired, "well in that county a title search costs $X but title insurance and hoping for the best costs $Y unless we take it to court then it costs $Z..." etc. See you can "make a market" in a campy going-thru-the-motions sense by having a semi-monopoly provider declaring an arbitrary list of prices on a chalkboard then calling that a free market. But making a functioning efficient market is a whole nother kettle of fish that requires a calm rational meeting of equal minds at a similar level of training and education to dispassionately trade interchangeable identical commodities, with the goal of all participants minimizing the spread between price and value. That's pretty much the opposite of good medical care.

bmelton 11y ago
I'm not really sure what your point is, so perhaps I missed something? Conflating a want for price transparency, so that I can spend rationally where that rationality can be logically exerted doesn't really seem to me a free market ideal as much as it is just common sense. There are many medical decisions made that aren't life or death, and in my admittedly anecdotal experience, that's been most of them. A great many medical demands are inelastic. When I lopped the (very) tip of my pinky finger off in an accident, it was nowhere near a dire enough injury to worry about the cost of repairs, but it did need stitches. Had there been a repair option, I might have opted for it, but only if the cost was reasonable. That said, we already know the market value of an ER doctor, or a radiologist; that's how we know what to pay them. It's not as though they're members of some secret cult of faceless men exacting arbitrary payments for their efforts. We know what it takes to pay them, and presumably, they could come up with an hourly cost for their labor plus materials if they so chose. It might take some practice, as estimation is hard, but basically every other service industry in the world is able to do it, so I can't imagine why the medical industry would be exempt. Regardless, sure, there are plenty of ailments that would hard to estimate, or meaningless to do so, but I don't see why that means nobody should try to do their jobs in a cost effective manner.

fluidcruft 11y ago

Indeed, hindsight does tend to clarify things significantly. Frankly, don't you think the better solution might have been to cue in on your doctor's hint that the additional testing wasn't needed? Maybe costs would have clarified things. Maybe cost isn't a meaningful proxy for medical judgment.

bmelton 11y ago
It's been some time, but if I'm recalling correctly, the doctor seemed in favor of the additional testing. Whether that was because he was genuinely concerned, scared of a malpractice suit from insufficient testing, or something else I'm not privy to, I wouldn't know. As I mentioned elsewhere, maybe cost isn't a meaningful proxy for medical judgement, but on relatively trivial matters like wrist sprains, minor cuts, etc., it may often be a good way to discriminate, assuming appropriate follow-up to ensure that the initial decision wasn't errantly done.