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>But I would also point out that under Capitalism, signing a contract usually involves the terms of that contract being made upfront. There's nothing inherent

>But I would also point out that under Capitalism, signing a contract usually involves the terms of that contract being made upfront. There's nothing inherent to Capitalism that prevents variable priced contracts. >Pretty much every other industry in America has figured out how to put a price tag on the products they sell, Maybe for mass produced products they have, but certainly not for custom work. You aren't paying for a product but for a custom service. Paying a doctor to fix your body in many cases is more complex than paying someone to build a house, a bridge, or a piece of software. You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing, now it's $50k. A builder starts digging the foundation to your house only to discover a huge boulder that has to be moved. There are parts of medicine that could be made more transparent, but there is an inherent complexity that makes complete or even mostly complete price transparency impossible.

danShumway 5y ago
> There's nothing inherent to Capitalism that prevents variable priced contracts. Definitely not the norm though, and it is inherent to Capitalism that price transparency is an important part of creating an efficient market. But sure, it's not a rule. A lot of common things in Capitalism aren't rules, but they're still often signals of a healthy market. > You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing. A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. > but there is an inherent complexity Not in the places that we're talking about. The kind of complexity and guesswork and change in procedure you're talking about is not present in the situations that jonathan-adly discusses above. The inherent complexity of fixing someone's body and the inherent variability of what drugs/procedures will be necessary to do so is a good explanation of why pricing a surgery or an entire hospital visit is very difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable".
- learc83 5y ago
  >Definitely not the norm though It most certainly is the norm when purchasing complex custom services. >A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. If a surgeon could keep your chest open on an operating table while they walked you through the process this analogy would work. >a good explanation of why pricing a surgery or an entire hospital visit may be difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable". jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront. As for the price os a single x-ray. I'm sure the average cost of a single x-ray could be calculated. But how much is that worth when the entirety of the hospital visit is going to be a variable cost? If you're only interested in a single x-ray, there are already outpatient imaging clinics that will give you the upfront cost.
  - danShumway 5y ago
    > It most certainly is the norm when purchasing complex custom services. An x-ray is not is not a complex custom service. > But how much is that worth when the entirety of the hospital visit is going to be a variable cost? This is the exact same argument that hospitals used to use against itemized pricing, and yet it turns out that requiring hospitals to give itemized bills on request has pretty solidly been a good thing for consumers. There are a huge number of reasons for this, not the least being fostering competition and putting natural pressure on the market to justify its prices helps it become more efficient, and these kinds of opaque systems will almost always naturally lead to inflated prices. There's little reason to believe that up-front price transparency for individual itemized procedures and drugs wouldn't also be good for the same reasons. At the very least, this would help with the many health decisions that consumers make that aren't happening during life-threatening situations. Most of the time that I get an x-ray, most of the time when I'm being offered pain medication, most of the time when I'm making decisions about whether or not to opt for anesthesia before a procedure, I'm awake and not in danger of immediately dying. It really doesn't make sense to keep leaning on the most extreme life-or-death situations as a defense for why a hospital can't walk me through the price differences in several different brands of pain medication. But sure, we'll make an exception for surgeons operating while a patient is literally unconscious during a time-sensitive procedure. Most health visits (and the vast majority of all preventative care procedures) do not fall into that category. > jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront. Let's make this simpler. johnathan-adly says: > The cost of the aspirin depends on these things Here's Rite-Aide's page that comes up when I search for an aspirin: https://www.riteaid.com/shop/medicine-health/pain-fever-relief/aspirin https://www.riteaid.com/shop/medicine-health/pain-fever-reli... Why is it that Rite-Aid can give me an upfront cost for an aspirin, and a hospital can't? 340B is a rebate system, it doesn't force doctors to avoid talking to patients about the baseline price differences between comparable off-the-shelf name-brand and generic drugs.

danShumway 5y ago

> There's nothing inherent to Capitalism that prevents variable priced contracts. Definitely not the norm though, and it is inherent to Capitalism that price transparency is an important part of creating an efficient market. But sure, it's not a rule. A lot of common things in Capitalism aren't rules, but they're still often signals of a healthy market. > You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing. A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. > but there is an inherent complexity Not in the places that we're talking about. The kind of complexity and guesswork and change in procedure you're talking about is not present in the situations that jonathan-adly discusses above. The inherent complexity of fixing someone's body and the inherent variability of what drugs/procedures will be necessary to do so is a good explanation of why pricing a surgery or an entire hospital visit is very difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable".

learc83 5y ago
>Definitely not the norm though It most certainly is the norm when purchasing complex custom services. >A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. If a surgeon could keep your chest open on an operating table while they walked you through the process this analogy would work. >a good explanation of why pricing a surgery or an entire hospital visit may be difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable". jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront. As for the price os a single x-ray. I'm sure the average cost of a single x-ray could be calculated. But how much is that worth when the entirety of the hospital visit is going to be a variable cost? If you're only interested in a single x-ray, there are already outpatient imaging clinics that will give you the upfront cost.
- danShumway 5y ago
  > It most certainly is the norm when purchasing complex custom services. An x-ray is not is not a complex custom service. > But how much is that worth when the entirety of the hospital visit is going to be a variable cost? This is the exact same argument that hospitals used to use against itemized pricing, and yet it turns out that requiring hospitals to give itemized bills on request has pretty solidly been a good thing for consumers. There are a huge number of reasons for this, not the least being fostering competition and putting natural pressure on the market to justify its prices helps it become more efficient, and these kinds of opaque systems will almost always naturally lead to inflated prices. There's little reason to believe that up-front price transparency for individual itemized procedures and drugs wouldn't also be good for the same reasons. At the very least, this would help with the many health decisions that consumers make that aren't happening during life-threatening situations. Most of the time that I get an x-ray, most of the time when I'm being offered pain medication, most of the time when I'm making decisions about whether or not to opt for anesthesia before a procedure, I'm awake and not in danger of immediately dying. It really doesn't make sense to keep leaning on the most extreme life-or-death situations as a defense for why a hospital can't walk me through the price differences in several different brands of pain medication. But sure, we'll make an exception for surgeons operating while a patient is literally unconscious during a time-sensitive procedure. Most health visits (and the vast majority of all preventative care procedures) do not fall into that category. > jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront. Let's make this simpler. johnathan-adly says: > The cost of the aspirin depends on these things Here's Rite-Aide's page that comes up when I search for an aspirin: https://www.riteaid.com/shop/medicine-health/pain-fever-relief/aspirin https://www.riteaid.com/shop/medicine-health/pain-fever-reli... Why is it that Rite-Aid can give me an upfront cost for an aspirin, and a hospital can't? 340B is a rebate system, it doesn't force doctors to avoid talking to patients about the baseline price differences between comparable off-the-shelf name-brand and generic drugs.