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I'm wondering if you have honestly ever been seriously ill or injured. Because no one is going to haggle properly when they're in unimaginable pain, or when th

I'm wondering if you have honestly ever been seriously ill or injured. Because no one is going to haggle properly when they're in unimaginable pain, or when their options are the local far more expensive doctor vs another that's hundreds of miles away, or when the illness is time critical. People need to stop thinking that somehow price transparency will solve problems that arise from mostly unpredictable circumstances.

AnthonyMouse 8y ago
The large majority of medical costs are not a result of time-critical decisions. A surgery that currently costs $50,000 may be scheduled weeks in advance. If a doctor 200 miles away would do it just as well for $10,000, how many people are going to say "nah, don't want to drive 200 miles, I'll just pay the extra $40,000"?
- fzeroracer 8y ago
  I can think of three groups of people. The first are people who can't take any time off from work. 200 miles away means less time working or less time managing family. I can think of a few circumstances where people lost their job as a result of such an injury, so for them the priority is feeding their family and then dealing with the bills later. Because you can put off medical bills, you can't put off food on the table. The second are people that are going to go bankrupt anyways. Why does it matter to them how much they're going to pay when they're losing literally everything anyways? Might as well go for the closer option since again, work and all. And finally the third are people that literally don't have the option to drive 200 miles. When my mother had her stroke she didn't have the option to go anywhere but the closest possible hospital, and post-stroke recovery had to be done locally. If you can't think of the dire circumstances people are in, then you've never been poor or have had to deal with seriously ill people. Think harder.
  - AnthonyMouse 8y ago
    > I can think of three groups of people. What about everybody else? Lowering the cost for everybody outside of three groups of people would still be pretty great. Especially since it would be hard for providers to justify specifically discriminating against your groups, so they would still benefit from competition lowering prices in general. > The first are people who can't take any time off from work. 200 miles away means less time working or less time managing family. I can think of a few circumstances where people lost their job as a result of such an injury, so for them the priority is feeding their family and then dealing with the bills later. Because you can put off medical bills, you can't put off food on the table. This feels pretty weak. You can't afford to take a day off work, but you can afford to pay an extra $40,000? Basically nobody is in that situation. If they incur the $40,000 debt, they'll not be paying it, so this is really just your second group. > The second are people that are going to go bankrupt anyways. Why does it matter to them how much they're going to pay when they're losing literally everything anyways? Might as well go for the closer option since again, work and all. But then they're not actually paying it. When charging $50,000 only means that it selects exclusively for people who will file for bankruptcy, the provider who does that is headed for bankruptcy itself, to be replaced by someone who realizes it's better to get $10,000 90% of the time than $50,000 ~0% of the time. > And finally the third are people that literally don't have the option to drive 200 miles. When my mother had her stroke she didn't have the option to go anywhere but the closest possible hospital, and post-stroke recovery had to be done locally. Isn't this just emergency care again? Emergency care is different. It makes sense to have the locality provide it in the same way they provide fire departments, with the purpose to stabilize the situation to the point that you (or whoever is making your decisions) has a chance to assess things and make a reasoned choice how to proceed further. It's also a small proportion of overall medical costs. And for recovery, we're just back to cost vs. convenience. If it was actually $40,000 more for each visit, it may still be worth driving 200 miles each time. If you had to drive 200 miles each way every day for ten years to save $40,000 once, well, that's another story. But the claim isn't that the further away place is always cheaper on net, it's that the fact that it sometimes can be would force the closer place to compete more on price. > If you can't think of the dire circumstances people are in, then you've never been poor or have had to deal with seriously ill people. Think harder. This kind of policy choice is literally a matter of life and death. Don't pretend you know the answer before you've had the debate. Being wrong is killing people one way or the other.

AnthonyMouse 8y ago

The large majority of medical costs are not a result of time-critical decisions. A surgery that currently costs $50,000 may be scheduled weeks in advance. If a doctor 200 miles away would do it just as well for $10,000, how many people are going to say "nah, don't want to drive 200 miles, I'll just pay the extra $40,000"?

fzeroracer 8y ago
I can think of three groups of people. The first are people who can't take any time off from work. 200 miles away means less time working or less time managing family. I can think of a few circumstances where people lost their job as a result of such an injury, so for them the priority is feeding their family and then dealing with the bills later. Because you can put off medical bills, you can't put off food on the table. The second are people that are going to go bankrupt anyways. Why does it matter to them how much they're going to pay when they're losing literally everything anyways? Might as well go for the closer option since again, work and all. And finally the third are people that literally don't have the option to drive 200 miles. When my mother had her stroke she didn't have the option to go anywhere but the closest possible hospital, and post-stroke recovery had to be done locally. If you can't think of the dire circumstances people are in, then you've never been poor or have had to deal with seriously ill people. Think harder.
- AnthonyMouse 8y ago
  > I can think of three groups of people. What about everybody else? Lowering the cost for everybody outside of three groups of people would still be pretty great. Especially since it would be hard for providers to justify specifically discriminating against your groups, so they would still benefit from competition lowering prices in general. > The first are people who can't take any time off from work. 200 miles away means less time working or less time managing family. I can think of a few circumstances where people lost their job as a result of such an injury, so for them the priority is feeding their family and then dealing with the bills later. Because you can put off medical bills, you can't put off food on the table. This feels pretty weak. You can't afford to take a day off work, but you can afford to pay an extra $40,000? Basically nobody is in that situation. If they incur the $40,000 debt, they'll not be paying it, so this is really just your second group. > The second are people that are going to go bankrupt anyways. Why does it matter to them how much they're going to pay when they're losing literally everything anyways? Might as well go for the closer option since again, work and all. But then they're not actually paying it. When charging $50,000 only means that it selects exclusively for people who will file for bankruptcy, the provider who does that is headed for bankruptcy itself, to be replaced by someone who realizes it's better to get $10,000 90% of the time than $50,000 ~0% of the time. > And finally the third are people that literally don't have the option to drive 200 miles. When my mother had her stroke she didn't have the option to go anywhere but the closest possible hospital, and post-stroke recovery had to be done locally. Isn't this just emergency care again? Emergency care is different. It makes sense to have the locality provide it in the same way they provide fire departments, with the purpose to stabilize the situation to the point that you (or whoever is making your decisions) has a chance to assess things and make a reasoned choice how to proceed further. It's also a small proportion of overall medical costs. And for recovery, we're just back to cost vs. convenience. If it was actually $40,000 more for each visit, it may still be worth driving 200 miles each time. If you had to drive 200 miles each way every day for ten years to save $40,000 once, well, that's another story. But the claim isn't that the further away place is always cheaper on net, it's that the fact that it sometimes can be would force the closer place to compete more on price. > If you can't think of the dire circumstances people are in, then you've never been poor or have had to deal with seriously ill people. Think harder. This kind of policy choice is literally a matter of life and death. Don't pretend you know the answer before you've had the debate. Being wrong is killing people one way or the other.