4 ms·

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

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.
- fzeroracer 8y ago
  >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. This reveals that you have an utterly fundamental misunderstanding of how things work in the US but I'll give it a shot at fixing the problem. For many people an extra X amount of debt means nothing to them. They're already knee-deep in debt paying back a lifetime of loans or medical issues. You're acting like people are paying the extra $40,000 upfront when in reality those costs are distributed out over the lifetime of a patient post-operation. Debt becomes more and more meaningless as you accept you can never afford to pay it back, so you focus on the immediate problems over the long terms. In fact this is why hospitals have so many issues. They can't actually get any money (you know, blood from a stone and all that) from the poor, so they squeeze money from the middle class and up in order to keep on the lights. The result is higher prices across the board for ludicrous things. >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. If that was true, then the system wouldn't have the problems that it does, now does it? It's simple and I'm sad I have to break this down to you: They charge ludicrous amounts knowing that they'll either get the baseline from the poor people over time ($10,000), or they'll get the absurdly overpriced amount from people that can afford it. This is why doctors and hospitals become debt collectors. >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. No, emergency care is not different. We have Americans using emergency care more and more often because the cost of regular care is through the roof. Even if prices were transparent, poor Americans that can't afford even basic preventative care will still end up further burdening emergency care because of how fucked up our system is. >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. You're right it's a matter of life and death. Which is why I argue so vigorously against bullshit solutions that do nothing to solve the problems that are brought up by people that have never had to deal with the depths of poverty or the shit poor/rural people have to put up with. Price transparency is nothing more than a feel-good measure that slaps a band-aid on the problem for upper-middle class people while continuing to give a middle-finger to the poor. The market is broken much like how the ISP market is a sham and thinking that competition will magically pop up if we just implement one or two changes like this is folly. I've seen and experienced what it can do to families.

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.

fzeroracer 8y ago
>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. This reveals that you have an utterly fundamental misunderstanding of how things work in the US but I'll give it a shot at fixing the problem. For many people an extra X amount of debt means nothing to them. They're already knee-deep in debt paying back a lifetime of loans or medical issues. You're acting like people are paying the extra $40,000 upfront when in reality those costs are distributed out over the lifetime of a patient post-operation. Debt becomes more and more meaningless as you accept you can never afford to pay it back, so you focus on the immediate problems over the long terms. In fact this is why hospitals have so many issues. They can't actually get any money (you know, blood from a stone and all that) from the poor, so they squeeze money from the middle class and up in order to keep on the lights. The result is higher prices across the board for ludicrous things. >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. If that was true, then the system wouldn't have the problems that it does, now does it? It's simple and I'm sad I have to break this down to you: They charge ludicrous amounts knowing that they'll either get the baseline from the poor people over time ($10,000), or they'll get the absurdly overpriced amount from people that can afford it. This is why doctors and hospitals become debt collectors. >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. No, emergency care is not different. We have Americans using emergency care more and more often because the cost of regular care is through the roof. Even if prices were transparent, poor Americans that can't afford even basic preventative care will still end up further burdening emergency care because of how fucked up our system is. >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. You're right it's a matter of life and death. Which is why I argue so vigorously against bullshit solutions that do nothing to solve the problems that are brought up by people that have never had to deal with the depths of poverty or the shit poor/rural people have to put up with. Price transparency is nothing more than a feel-good measure that slaps a band-aid on the problem for upper-middle class people while continuing to give a middle-finger to the poor. The market is broken much like how the ISP market is a sham and thinking that competition will magically pop up if we just implement one or two changes like this is folly. I've seen and experienced what it can do to families.