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The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m

by cdjk 6y ago

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems so much more straightforward.

mehrdadn 6y ago
> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)
- HeyImAlex 6y ago
  Seriously, I’ve had dentists differ in opinions by an order of magnitude. Turns out “necessary” is a pretty broad grey area.
- cdjk 6y ago
  True, but at least the dentist can tell me how much I will need to pay.
  - mehrdadn 6y ago
    Which one is better probably depends on if you value your money more, or your body.
  - learc83 6y ago
    That's because most common dental procedures are relatively straightforward and the mechanical processes of the mouth are relatively well understood compared to most of the rest of the body. Plus most dental procedures are elective in the sense that you can usually just have an offending tooth pulled if it gets too bad, so for most people there's a price ceiling that is much lower than say a lifesaving heart procedure.
    - umvi 6y ago
      Why can't a hospital tell me how much an xray costs then? If I come in with a broken arm, why can't they tell me how much it will cost to get it xrayed yet the dentist can do the exact same thing with a broken tooth?
      - learc83 6y ago
        A dentist office is more comparable to an urgent care clinic than a hospital. And in many cases an urgent care clinic can tell you what simple procedures will cost. There are imaging services companies that can tell you upfront how much diagnostic tests are going to cost as well. A broken tooth is a much less complex injury than a broken arm. In many cases you don't even need to be a dentist to diagnose it. Try walking into a dentist office with a more complex injury that could involve multiple different dental specialties and severe underlying complications. You aren't going to get an immediate upfront price.
        mehrdadn 6y ago
        I don't understand how this answers the question about X-ray cost.
        learc83 6y ago
        1. Dental x-rays are more straightforward and involve fewer people, so the price is easier to calculate. 2. Dental x-rays are more often than not elective procedures. It's much easier to comparison shop elective procedures than emergency procedures. Therefore market forces frequently compel the dentist to come up with an up front cost for an x-ray. The same market forces don't apply to hospitals because you can't wait a week or more while you shop around for treatment for a shattered hip.
- sokoloff 6y ago
  I consistently tell my dentist to make treatment decisions as if this were her mouth/teeth. Of course, I'll never know if that gives her a license to "go profitable" over "go optimal", but I'm also extremely unlikely to go chase multiple opinions over a cracked tooth or filling.
- daveFNbuck 6y ago
  Doctors disagree about medical treatment too. At least with the dentist you'll know how much each opinion costs.
  - deleted 6y ago
    [deleted]
- mattkrause 6y ago
  I asked my new dentist why her recommendations were so different from her predecessor. She said that there's not always one "correct" treatment. Some dentists will try to nip potential problems in the bud, lest they get worse. Others have more of a wait-and-see attitude which can avoid some procedures but make others worse. Doctors, plumbers, builders, and mechanics all do the same thing. Do you replace the brake pads now, while the wheels are off anyway, or do you squeeze another season out of them since there's still a bit left? Rebuild the whole deck, or maybe just replace the more banged up boards and wobbly railing?
  - astura 6y ago
    Difference being is all break pads eventually wear out and need to be replaced and all decks need regular maintenance. Not all teeth are going to eventually need work. Plus the huge disparity in recommended treatments is an indication some are just throwing shit at the wall to see what sticks: https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/ https://www.theatlantic.com/magazine/archive/2019/05/the-tro... >Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.
- AdrianB1 6y ago
  Same as code refactoring, needing it is a very subjective matter even is similar circumstances.
tehjoker 6y ago
Price discovery doesn't help you. If you get knocked out, heart attack, your arm cut off, whatever (i.e. a lot of the expensive stuff) you just go to the nearest hospital, no consumer market finagling is even possible other than trying to live near a good hospital. Other times with chronic conditions where theoretically price discovery could help, the problem is that you need care badly so all the chronic care providers jack up the prices super high beyond what is needed. Treating this as a market in any way is a crazy system. If the government pays market rate, they jack it up even more. So the solution has to be that the government has to set the prices either directly or by negotiating with an entire population at its back and no competitors (i.e. monopsony in the public interest).
- cpuguy83 6y ago
  The sad thing is, as expensive as healthcare is they probably have to jack up those rates because they are getting screwed everywhere else. In the end, though, the consumer is always the one who ends up getting the ultimate screw... exactly why healthcare shouldn't be seen as a service to consume.
  - newen 6y ago
    You don't really need anyone else screwing over the hospital to have for-profit hospitals be incentivized to screw the patient by jacking up prices on demand inelastic goods. Not to even mention that many times the patient chooses these procedures while not thinking clearly, when under duress, etc.
  - jschwartzi 6y ago
    These organizations charge exorbitant amounts of money for the care they provide. This is care which very few people are able to refuse. And if you do refuse care you are likely to die. What hospitals do would be considered extortion if a private citizen did it. I have no sympathy for them whatsoever.
    - cpuguy83 6y ago
      Sympathy has nothing to do with it.
jsperson 6y ago
> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected side benefit is that a large percentage of their patients are un/underinsured. They can quote the prices for most common procedures from memory. The other day I was getting a blood test and they asked if I wanted to bill my insurance or pay cash for it. I asked about the cost and they said "two-sixty". My response: "For two hundred sixty bucks we better bill the insurance. They laughed: no, $2.60 (it was an add on to another test for my physical). When I got home I googled pricing - the exact same test normally bills for around $65. We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets. Thus the best way forward is to try what has been successful elsewhere.
- cpuguy83 6y ago
  The annoying thing is, most people would agree that the whole system sucks... until you start talking about politics and suddenly you'd think a bunch of people have a love affair with their insurance company and healthcare providers.
  - DangitBobby 6y ago
    "People love their insurance!" Is a dead giveaway that a politician is a sock puppet. Biden kept saying it during the primaries.
    - agensaequivocum 6y ago
      I'm not a politician and I will say: I love my insurance. Because it's actually pretty great.
      - 6y ago
OkGoDoIt 6y ago
On the other hand, try calling ahead to various dentists in order to find the one that has the cheapest price for the procedure you need to have done. Surprisingly difficult. Not as impossible as in other aspects of healthcare, but I spent hours and hours and mostly didn’t get the details I wanted
goldenManatee 6y ago
And often every price the dental office provides you is an estimate, as once they enter each procedure’s code the insurance may price that work above or below the estimated price. That’s dental, which often isn’t life or death. If you’re in an ER or ICU you’re not processing “by golly, can I afford saving myself or should I negotiate the hospital’s Tylenol?”
claudeganon 6y ago
This is hilarious sentiment to me because I’ve found it harder to find an honest dentist than an honest doctor. My experience is that they’re always trying to upsell you or perform unnecessary procedures. The only good dentist I’ve had was a guy that specifically served working class people. He knew there was little upside in trying to screw people over (they’d either skip necessary work or just not pay the bills) and was completely open about everything from treatment options to their respective costs.
yboris 6y ago
> Try getting a price for a procedure or visit beforehand "I tried to find out how much my son’s birth would cost. No one would tell me." [0] [0] https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bills https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...
- lotsofpulp 6y ago
  The answer is always “your out of pocket maximum” if it’s all done with in network providers, and infinity if any out of network providers are involved.
  - deleted 6y ago
    [deleted]
  - thaeli 6y ago
    Which is a problem when out of network providers sneak in, such as commonly happens with surgical assistants. Have a covered and pre approved procedure from an in network surgeon at an in network hospital, and then oops because the surgeon added someone else to the room they never told you about now here's an out of network bill.
maximente 6y ago
there seem to be alternatives for e.g. non emergency surgeries. this organization has prices listed which include follow ups, anesthesiologist, etc. https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/ they also seem to have a lower risk of infection compared to the national average: https://surgerycenterok.com/faqs/ https://surgerycenterok.com/faqs/ i'm not sure what could account for that. i was thinking that maybe because they are incentivized to provide the procedure at the baked in rate that there's a strong incentive to get patients out of surgery successfully as best as possible (to free up another bed, etc), but i'm not sure what their demand is like. a more macabre hypothesis is that hospitals don't care much about patients who end up in their own ICU as it's just additional billable coverage, so the precautions aren't as strict.
stevebmark 6y ago
How is that not a "free market"? Private, corrupt back room business deals dictate the prices that screw over patients. It's entirely determined by the private market. That sounds like a free market to me.
sjg007 6y ago
My dentist obscures things... I have msrp then estimated personal contribution. Only later do I get the final negotiated rates. Usually I get money back. Also with a dental PPO to go out of network you have to negotiate yourself! Insurance will only reimburse zip code rates.

by cdjk 6y ago

mehrdadn 6y ago

> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)

HeyImAlex 6y ago
Seriously, I’ve had dentists differ in opinions by an order of magnitude. Turns out “necessary” is a pretty broad grey area.
cdjk 6y ago
True, but at least the dentist can tell me how much I will need to pay.
- mehrdadn 6y ago
  Which one is better probably depends on if you value your money more, or your body.
- learc83 6y ago
  That's because most common dental procedures are relatively straightforward and the mechanical processes of the mouth are relatively well understood compared to most of the rest of the body. Plus most dental procedures are elective in the sense that you can usually just have an offending tooth pulled if it gets too bad, so for most people there's a price ceiling that is much lower than say a lifesaving heart procedure.
  - umvi 6y ago
    Why can't a hospital tell me how much an xray costs then? If I come in with a broken arm, why can't they tell me how much it will cost to get it xrayed yet the dentist can do the exact same thing with a broken tooth?
    - learc83 6y ago
      A dentist office is more comparable to an urgent care clinic than a hospital. And in many cases an urgent care clinic can tell you what simple procedures will cost. There are imaging services companies that can tell you upfront how much diagnostic tests are going to cost as well. A broken tooth is a much less complex injury than a broken arm. In many cases you don't even need to be a dentist to diagnose it. Try walking into a dentist office with a more complex injury that could involve multiple different dental specialties and severe underlying complications. You aren't going to get an immediate upfront price.
      - mehrdadn 6y ago
        I don't understand how this answers the question about X-ray cost.
        learc83 6y ago
        1. Dental x-rays are more straightforward and involve fewer people, so the price is easier to calculate. 2. Dental x-rays are more often than not elective procedures. It's much easier to comparison shop elective procedures than emergency procedures. Therefore market forces frequently compel the dentist to come up with an up front cost for an x-ray. The same market forces don't apply to hospitals because you can't wait a week or more while you shop around for treatment for a shattered hip.
sokoloff 6y ago
I consistently tell my dentist to make treatment decisions as if this were her mouth/teeth. Of course, I'll never know if that gives her a license to "go profitable" over "go optimal", but I'm also extremely unlikely to go chase multiple opinions over a cracked tooth or filling.
daveFNbuck 6y ago
Doctors disagree about medical treatment too. At least with the dentist you'll know how much each opinion costs.
- deleted 6y ago
  [deleted]
mattkrause 6y ago
I asked my new dentist why her recommendations were so different from her predecessor. She said that there's not always one "correct" treatment. Some dentists will try to nip potential problems in the bud, lest they get worse. Others have more of a wait-and-see attitude which can avoid some procedures but make others worse. Doctors, plumbers, builders, and mechanics all do the same thing. Do you replace the brake pads now, while the wheels are off anyway, or do you squeeze another season out of them since there's still a bit left? Rebuild the whole deck, or maybe just replace the more banged up boards and wobbly railing?
- astura 6y ago
  Difference being is all break pads eventually wear out and need to be replaced and all decks need regular maintenance. Not all teeth are going to eventually need work. Plus the huge disparity in recommended treatments is an indication some are just throwing shit at the wall to see what sticks: https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/ https://www.theatlantic.com/magazine/archive/2019/05/the-tro... >Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.
AdrianB1 6y ago
Same as code refactoring, needing it is a very subjective matter even is similar circumstances.

tehjoker 6y ago

Price discovery doesn't help you. If you get knocked out, heart attack, your arm cut off, whatever (i.e. a lot of the expensive stuff) you just go to the nearest hospital, no consumer market finagling is even possible other than trying to live near a good hospital. Other times with chronic conditions where theoretically price discovery could help, the problem is that you need care badly so all the chronic care providers jack up the prices super high beyond what is needed. Treating this as a market in any way is a crazy system. If the government pays market rate, they jack it up even more. So the solution has to be that the government has to set the prices either directly or by negotiating with an entire population at its back and no competitors (i.e. monopsony in the public interest).

cpuguy83 6y ago
The sad thing is, as expensive as healthcare is they probably have to jack up those rates because they are getting screwed everywhere else. In the end, though, the consumer is always the one who ends up getting the ultimate screw... exactly why healthcare shouldn't be seen as a service to consume.
- newen 6y ago
  You don't really need anyone else screwing over the hospital to have for-profit hospitals be incentivized to screw the patient by jacking up prices on demand inelastic goods. Not to even mention that many times the patient chooses these procedures while not thinking clearly, when under duress, etc.
- jschwartzi 6y ago
  These organizations charge exorbitant amounts of money for the care they provide. This is care which very few people are able to refuse. And if you do refuse care you are likely to die. What hospitals do would be considered extortion if a private citizen did it. I have no sympathy for them whatsoever.
  - cpuguy83 6y ago
    Sympathy has nothing to do with it.

jsperson 6y ago

> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected side benefit is that a large percentage of their patients are un/underinsured. They can quote the prices for most common procedures from memory. The other day I was getting a blood test and they asked if I wanted to bill my insurance or pay cash for it. I asked about the cost and they said "two-sixty". My response: "For two hundred sixty bucks we better bill the insurance. They laughed: no, $2.60 (it was an add on to another test for my physical). When I got home I googled pricing - the exact same test normally bills for around $65. We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets. Thus the best way forward is to try what has been successful elsewhere.

cpuguy83 6y ago
The annoying thing is, most people would agree that the whole system sucks... until you start talking about politics and suddenly you'd think a bunch of people have a love affair with their insurance company and healthcare providers.
- DangitBobby 6y ago
  "People love their insurance!" Is a dead giveaway that a politician is a sock puppet. Biden kept saying it during the primaries.
  - agensaequivocum 6y ago
    I'm not a politician and I will say: I love my insurance. Because it's actually pretty great.
    - 6y ago

OkGoDoIt 6y ago

On the other hand, try calling ahead to various dentists in order to find the one that has the cheapest price for the procedure you need to have done. Surprisingly difficult. Not as impossible as in other aspects of healthcare, but I spent hours and hours and mostly didn’t get the details I wanted

goldenManatee 6y ago

And often every price the dental office provides you is an estimate, as once they enter each procedure’s code the insurance may price that work above or below the estimated price. That’s dental, which often isn’t life or death. If you’re in an ER or ICU you’re not processing “by golly, can I afford saving myself or should I negotiate the hospital’s Tylenol?”

claudeganon 6y ago

This is hilarious sentiment to me because I’ve found it harder to find an honest dentist than an honest doctor. My experience is that they’re always trying to upsell you or perform unnecessary procedures. The only good dentist I’ve had was a guy that specifically served working class people. He knew there was little upside in trying to screw people over (they’d either skip necessary work or just not pay the bills) and was completely open about everything from treatment options to their respective costs.

yboris 6y ago

> Try getting a price for a procedure or visit beforehand "I tried to find out how much my son’s birth would cost. No one would tell me." [0] [0] https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bills https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...

lotsofpulp 6y ago
The answer is always “your out of pocket maximum” if it’s all done with in network providers, and infinity if any out of network providers are involved.
- deleted 6y ago
  [deleted]
- thaeli 6y ago
  Which is a problem when out of network providers sneak in, such as commonly happens with surgical assistants. Have a covered and pre approved procedure from an in network surgeon at an in network hospital, and then oops because the surgeon added someone else to the room they never told you about now here's an out of network bill.

maximente 6y ago

there seem to be alternatives for e.g. non emergency surgeries. this organization has prices listed which include follow ups, anesthesiologist, etc. https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/ they also seem to have a lower risk of infection compared to the national average: https://surgerycenterok.com/faqs/ https://surgerycenterok.com/faqs/ i'm not sure what could account for that. i was thinking that maybe because they are incentivized to provide the procedure at the baked in rate that there's a strong incentive to get patients out of surgery successfully as best as possible (to free up another bed, etc), but i'm not sure what their demand is like. a more macabre hypothesis is that hospitals don't care much about patients who end up in their own ICU as it's just additional billable coverage, so the precautions aren't as strict.

stevebmark 6y ago

How is that not a "free market"? Private, corrupt back room business deals dictate the prices that screw over patients. It's entirely determined by the private market. That sounds like a free market to me.

sjg007 6y ago

My dentist obscures things... I have msrp then estimated personal contribution. Only later do I get the final negotiated rates. Usually I get money back. Also with a dental PPO to go out of network you have to negotiate yourself! Insurance will only reimburse zip code rates.