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This is such an awful take. So if a doctor prescribes a medicine and the patient never takes it and the patient dies it is somehow the doctor's fault or they do

This is such an awful take. So if a doctor prescribes a medicine and the patient never takes it and the patient dies it is somehow the doctor's fault or they don't get paid? Some doctors are greedy. Some ________ are greedy. There are major factors in the waste in our health care system but by and large it isn't doctor's fees. There are so many rent seekers taking a cut. There are other models than fee-for-service. They have tried population health models where the Provider (Dr, nurse, etc.) get $X per person per year. They are incentivized to be more preventative where they basically get to keep whatever they don't spend on patient care. However, you can lead a horse to water but can't make him drink. Ask yourself this: would you write web code where you got paid based on how many unique visitors viewed the page your wrote? We can easily fix health care with a few simple changes but there is no real appetite to do so. One simple change is to go to referenced based pricing. You can't charge more than 1.2 the Medicare reimbursement. This change alone would reduce our spending by 25%.

rsj_hn 5y ago
> One simple change is to go to referenced based pricing. You can't charge more than 1.2 the Medicare reimbursement. Agree that this is huge. Price transparency, reference pricing. You know "the law of one price" is supposed to be a pillar of market economics, so this should be a no-brainer. Additionally, don't allow charging more than the insurance will pay with the exception of an agreed upon co-pay ahead of time. If a hospital accepts insurance, then it shouldn't be able to send you a bill later on that the insurance refuses to pay. That needs to be worked out between the hospital and the insurer. I would also like to see binding quotes before any procedure, with no surprise billing.
- sokoloff 5y ago
  Most of us have been in a codebase for an issue that turns out larger or more complex than first understood. I don’t want to undergo surgery for cancer X, have the surgeon see nearby, related cancer Y and sew me back up and tell me I also have cancer Y but that he didn’t want to go over the estimate. When asked for a choice by a medical professional (or a home improvement contractor for that matter), I will more often than not ask “if you were in my shoes, what would you do?” I don’t 100% of the time go with what they say, but I think it helps me understand their expertise and judgment better. In the surgical case above, if the surgeon would have taken it out and given me a single recovery experience and told me about the bill when I woke up, I’m probably better off for it.
  - rsj_hn 5y ago
    So in a surgery situation where you are under and something else is discovered, then that's a situation of unexpected costs. So you look to who is best able to bear them and that's who bears them. What exactly is the purpose of insurance if they do not cover you from unexpected costs? And if there is no insurance (say a cash procedure), then the hospital bears the cost and bakes the possibility of complications into the price. Point is, you need clarity of prices rather than the situation today where you sign a promise to pay whatever costs the hospital decides to charge you, and you may not even know what those are until weeks after the procedure. There is no meaningful way a market can operate under conditions in which blank checks are demanded in order to get anything done. If that can't work, and the hospital insists it cannot quote you a cost at all, then go full socialized healthcare since obviously no market is possible.
- snarf21 5y ago
  And then you have the current bs where the anesthesiologist for your operation at the hospital system that you always use is somehow un-affiliated and out of network even if everything else in that system is in network.

rsj_hn 5y ago

> One simple change is to go to referenced based pricing. You can't charge more than 1.2 the Medicare reimbursement. Agree that this is huge. Price transparency, reference pricing. You know "the law of one price" is supposed to be a pillar of market economics, so this should be a no-brainer. Additionally, don't allow charging more than the insurance will pay with the exception of an agreed upon co-pay ahead of time. If a hospital accepts insurance, then it shouldn't be able to send you a bill later on that the insurance refuses to pay. That needs to be worked out between the hospital and the insurer. I would also like to see binding quotes before any procedure, with no surprise billing.

sokoloff 5y ago
Most of us have been in a codebase for an issue that turns out larger or more complex than first understood. I don’t want to undergo surgery for cancer X, have the surgeon see nearby, related cancer Y and sew me back up and tell me I also have cancer Y but that he didn’t want to go over the estimate. When asked for a choice by a medical professional (or a home improvement contractor for that matter), I will more often than not ask “if you were in my shoes, what would you do?” I don’t 100% of the time go with what they say, but I think it helps me understand their expertise and judgment better. In the surgical case above, if the surgeon would have taken it out and given me a single recovery experience and told me about the bill when I woke up, I’m probably better off for it.
- rsj_hn 5y ago
  So in a surgery situation where you are under and something else is discovered, then that's a situation of unexpected costs. So you look to who is best able to bear them and that's who bears them. What exactly is the purpose of insurance if they do not cover you from unexpected costs? And if there is no insurance (say a cash procedure), then the hospital bears the cost and bakes the possibility of complications into the price. Point is, you need clarity of prices rather than the situation today where you sign a promise to pay whatever costs the hospital decides to charge you, and you may not even know what those are until weeks after the procedure. There is no meaningful way a market can operate under conditions in which blank checks are demanded in order to get anything done. If that can't work, and the hospital insists it cannot quote you a cost at all, then go full socialized healthcare since obviously no market is possible.
snarf21 5y ago
And then you have the current bs where the anesthesiologist for your operation at the hospital system that you always use is somehow un-affiliated and out of network even if everything else in that system is in network.