6 ms·

Relying on the patient to gauge what is fair pricing & what is gouging, then haggle when they get the bill seems like trying to solve the problem from the wrong

by Klinky 4y ago

Relying on the patient to gauge what is fair pricing & what is gouging, then haggle when they get the bill seems like trying to solve the problem from the wrong end. Free marketeers will say a fair price is what someone is willing to pay. Trying to make price decisions when your health is in the balance seems like it will lead to either poor decisions on price or on health. These attempts at pricing transparency seem like another way to put blame on the patient for making "poor choices" when really the system needs to be less complex for the patient. Let auditors & regulators handle pricing and gouging, ideally within a single-payer/public option system.

mikepurvis 4y ago
Yeah. I know Americans tire of hearing about the rest of the world on this issue, but truly the only sane way for this to be is where you go to the hospital and literally never see a bill. This is how it is in Canada. Our politicians are currently busy fighting over dental, optical, and prescription drugs [1], and truthfully that's just as baffling— why should going to the dentist be any different than going to the hospital? Is getting eyeglasses somehow "elective"? [1]: https://www.ndp.ca/better-care?focus=13934141 https://www.ndp.ca/better-care?focus=13934141
- komali2 4y ago
  Even if I put my capitalism hat on I don't understand why one would argue against socialized healthcare. You want productive workers, with the cost amortized across the entire population, don't you? You like that your workers have roads to drive on to get to work, right? You like that there's infrastructure you can leverage for them to make sales phone calls, surely? The entire value of your business is basically leveraged on the fact that there's a national and global supply chain infrastructure amortized by taxpayers, socialized, and nationalized programs, right?
  - mikepurvis 4y ago
    Exactly, yeah. It really is baffling how both the argument against socialized medicine and the argument for socialized road infrastructure both somehow became about freedom— one is the freedom to choose where and when and whether to get care, and the other is the freedom to go wherever you want in your personal vehicle at no cost. Or maybe it's about what you didn't pay for? Freedom is not having to have your taxes pay for someone else's surgery, but roads are a good deal as long as you drive as much as possible on them? Anyway, as a four season bike commuter and mass transit fan, it seems to me that being a slave to automobile manufacturers and oil companies and urban sprawl is the opposite of freedom, but I don't have a century of concerted propaganda on my side for that position, so most people look at me like I have three heads.
  - dmitrygr 4y ago
    > Even if I put my capitalism hat on I don't understand why one would argue against socialized healthcare. Honest answer: because currently my family and I have access to above-average care at below-average wait times due to having money. This will go away necessarily due to math. So asking people who are lucky enough to be in this position to support socialized healthcare is tantamount to asking them to value the lives of randoms more than those of their family.
    - mikepurvis 4y ago
      I get this perspective, and it's no judgment on you specifically for holding it, but from my point of view as another upper middle class person, my quality of life is also improved when my neighbours have the care they need. I don't want to have to live in a gated community so that I can shut out the lepers, and that extends to things like schools too— I want a public school system that gives every kid a decent chance of succeeding and that goes the extra mile to provide supports to those who face additional challenges at home. Even at the cost of a potential opportunity for my own kid. Most of the world is not a zero sum game: the solution to scarcity is to invest and make more of it, not to fight over the scraps. “I am, somehow, less interested in the weight and convolutions of Einstein’s brain than in the near certainty that people of equal talent have lived and died in cotton fields and sweatshops.” — Stephen Jay Gould
      - AnIdiotOnTheNet 4y ago
        > I get this perspective, and it's no judgment on you specifically for holding it I'll judge them for holding it. They want the benefits of a society, then they should support that society. Otherwise the message is that they're totally ok with having a slave labor class that drives their Uber for them and picks up their take out order for them, but fuck those people when they get sick.
        dmitrygr 4y ago
        Yes, let me clarify: Fuck everyone and everything, if it extends the life of my family member by even a day. Judge me all you want
- rjh29 4y ago
  Japan has an interesting approach - you have health insurance that makes everything dirt cheap, but even without insurance they don't charge ridiculous American-style prices. While on holiday I saw a doctor for 3000yen ($20) and a dentist for 4500yen ($32 incl. x-ray and meds) without any local insurance. It's actually much better than the UK for dentists at least.
- refurb 4y ago
  Canada is also facing massive wait times. Plenty of people can't even get a family doctor, they simply aren't taking them any more. Manitoba is sending 300 spinal surgery patients to North Dakota because they can't clear the backlog any other way. https://www.cbc.ca/news/canada/manitoba/manitoba-surgeries-north-dakota-fargo-wfpcbc-cbc-1.6319862 https://www.cbc.ca/news/canada/manitoba/manitoba-surgeries-n...
  - maxehmookau 4y ago
    Sure. Under the US system, they "fix" this problem by pricing people out of the queues and they end up dying. I could reduce the demand for anything if I'm allowed to arbitrarily raise its price.
    - refurb 4y ago
      So the alternative is apparently just the government enforcing a queue to the point people can't get the surgery they need? Is that better?
      - AnIdiotOnTheNet 4y ago
        Plenty of people already aren't getting the treatment they need under the US model, only difference will be that your access to treatment is not as directly correlated to your wealth.
        refurb 4y ago
        That's not true since the lower income bands have Medicaid which is more generous than Canadian healthcare.
        thephyber 4y ago
        > Medicaid which is more generous than Canadian healthcare You assume that Medicaid is accepted. It's increasingly difficult to find providers that will accept it. From 2015: > A 2011 nationwide survey of doctors found 31 percent were “unwilling” to accept new Medicaid patients, with acceptance rates across states varying widely. Across the nation, the study estimated 69 percent of doctors were accepting Medicaid, but state acceptance rates ranged from a low of 40 percent in New Jersey to 99 percent in Wyoming, according to the study published in Health Affairs. This was pre-ACA expansion and prior to any reimbursement fee changes.[1] > When comparing reimbursement rates among health insurance plans, Medicaid is the lowest payer, meaning it’s not a moneymaker for doctors’ offices. Paired with the administrative requirements of accepting public insurance, doctors sometimes just don’t want the hassle.[1] [1] https://health.usnews.com/health-news/health-insurance/articles/2015/05/26/youve-got-medicaid-why-cant-you-see-the-doctor https://health.usnews.com/health-news/health-insurance/artic...
jandrese 4y ago
> Free marketeers will say a fair price is what someone is willing to pay. Which is exactly why the system is broken. How much are you willing to spend to not die? Healthcare is one of those things that markets just aren't good at setting prices for. The demand curve is a wreck. I think the US has proved conclusively that a market based approach is a mistake.
- SoftTalker 4y ago
  > How much are you willing to spend to not die? Of course most health care is not an immediate life or death situation. Most of it is for chronic issues or routine "well care" where you would have ample time to compare prices at different providers, if there were a straightforward way to do that.
  - ClumsyPilot 4y ago
    Time is an important component, but is not enough. Tere is no utility price - for example if all tv producers conspire and set TV prices at $10,000 for entry level tv i will go without one. So will all consumers. Thats your price limit. However that does not apply to medicine, see epipen scandal. prices can be inceeased infinitely. Also Many medicines enjoy patent protection and thus have no competition,
    - thephyber 4y ago
      While what you say is mostly true, it's not the whole story. Price transparency doesn't fix price fixing, broken intellectual property laws, etc. But it does increase competition in a space where opacity is currently a feature. Americans are paying so much that medical visits to other countries are affordable. Trips to Mexico or Canada to purchase medicines. Trips to Europe to get a hip replacement. The fact that "Medical tourism" even has a term means that Americans are searching for ways to reduce cost. Price transparency is a tool, even if it's debatable about how big the lever is.
  - komali2 4y ago
    For non life or death things, it's still kind of, idk, what's a good economic word to describe "something you basically have to / will inevitably buy?" Your arm is broken and was put in a splint. To get the splint removed properly you gotta go back to the hospital for them to saw it off (and xray to determine it's a good time to saw the thing off). You're gonna... shop around and compare prices for this routine? I mean, you HAVE to get the splint off or your arm will rot off, plus, your quality of life is reduced with it on. "The Market" is armed with the knowledge that you've gotta get the thing off. Even with a couple hospital "options," the hospitals and insurance companies can collude (implicitly or otherwise) to charge basically whatever they want for the operation. The question isn't, what's a fair price, the question is, how much of this person's income can we extract before they'll risk cutting the thing off themselves. It seems irrational to try to justify this environment when considering the needs of the citizenry. All signs point to methods of organizing healthcare that take as much power as possible from "the market" (which just means whoever can form oligopoly), be that by having a single payer system or by simply nationalizing healthcare.
tapatio 4y ago
Or the opposite approach - stop mandating hospitals must accept any patient, regardless of their ability to pay. I bet hospitals would all of a sudden become affordable as they want to capture "low-income" market share.
- Klinky 4y ago
  Certain procedures are expensive & complicated regardless. Someone having a heart attack, stroke or severe COVID, would require extensive care. If you're okay letting such patients just die due to lack of funds, then this concept might work. Ethically & morally deplorable perhaps, but honest towards the goals of brutalistic capitalism.
  - deleted 4y ago
    [deleted]
- thephyber 4y ago
  "hospitals" aren't required to do that. Only emergency rooms are[1]. The point: not all hospitals have emergency rooms. And the problem is less about what you claim (although some of the claim is valid). The core problem with required/not-required dichotomy is that cheap preventative care visits are not required, but expensive emergency care is, hence the average cost approaches the latter as people substitute the former for the latter. > In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay.[1] [1] https://www.cms.gov/regulations-and-guidance/legislation/emtala https://www.cms.gov/regulations-and-guidance/legislation/emt...
BurningFrog 4y ago
> Relying on the patient to gauge what is fair pricing & what is gouging, then haggle when they get the bill... You're making a good argument against something no one has proposed. The point of this effort is to be able to know the cost of something before you buy it. That's it! How this can "seem like another way to put blame on the patient" is pretty incomprehensible.
- Klinky 4y ago
  Simply put "Couldn't afford the care? Should've shopped around!". It feels like a non-solution solution to access to healthcare. In theory it's great to have transparency, but in reality this is just pushing responsibility & complexity onto patients, all to continue a facade that market-based economic models work well for patient care & will magically drive down costs.
  - BurningFrog 4y ago
    I honestly don't understand your point. Do you also consider stores having price information bad? Would it be better if I went to Target, picked what I wanted, and then got a bill with the surprising cost 3 weeks later? > It feels like a non-solution solution to access to healthcare. That's correct. It addresses a different problem.
    - Klinky 4y ago
      Do you have years of medical & diagnostic coding experience along with medical training to properly interpret pricing data for a multitude of procedures with wide ranging scenarios? You're not going to Target to buy Cheerios here. Pricing transparency is a band-aid on the gaping wound that is US healthcare. More numbers to consider that may or may not apply based on your insurance policy & other factors. Let's also add some middle-men to aggregate and "find the best price".
refurb 4y ago
Disagree. The free market works great for things like Lasik surgery and cosmetic surgery. Patients shop around, get referrals, make a call and pay. The problem in the US is that's not free market. How can it be a free market if the price isn't posted or isn't known until after the purchase? How can it be a free market if people with good insurance don't care about the cost because they only pay some insignificant portion of it?
- Klinky 4y ago
  Why wouldn't a free market collude and monopolize to maximize profit? Idealized free markets require perfect information. Most consumers of healthcare are woefully ill informed on healthcare matters. The problem with free markets is summed up with phrases like: "caveat emptor", "a fool & his money are easily parted", "there's a sucker born every minute", "penny wise, pound foolish". Discount laser eye surgery has its own issues with deceptive advertising, misleading pricing, patients being rushed & not fully informed of potential side effects or receiving poor post-op care. People really need to research thoroughly before using a coupon for their laser eye surgery. No one should expect the market to just provide a quality product. That's foolish thinking.
  - refurb 4y ago
    The free market doesn’t collide when there is competition. Just like oil cartels, they barely hold together because the first person to leave the cartel makes way more money undercutting everyone else. And many of those issues of rushing patients and not explaining risks happens in public systems too. You think doctors work for free in those systems? And in terms of quality you’d be a fool to not check even in a public system. I worked in the healthcare field and quality of doctors varies widely.
    - Klinky 4y ago
      OPEC holds huge power over global oil markets, and is not "barely held together". Com'on. Competition colluding or conglomerating is not uncommon. Much of brand competition is actually various arms of the same parent company. The illusion of competition. My point was the free market you lauded for Lasik is a mixed bag with some potentially good value for money, but also deceptive salesmen muddying the waters for consumers to make valid comparisons on price & quality. It's no panacea.

by Klinky 4y ago

mikepurvis 4y ago

Yeah. I know Americans tire of hearing about the rest of the world on this issue, but truly the only sane way for this to be is where you go to the hospital and literally never see a bill. This is how it is in Canada. Our politicians are currently busy fighting over dental, optical, and prescription drugs [1], and truthfully that's just as baffling— why should going to the dentist be any different than going to the hospital? Is getting eyeglasses somehow "elective"? [1]: https://www.ndp.ca/better-care?focus=13934141 https://www.ndp.ca/better-care?focus=13934141

komali2 4y ago
Even if I put my capitalism hat on I don't understand why one would argue against socialized healthcare. You want productive workers, with the cost amortized across the entire population, don't you? You like that your workers have roads to drive on to get to work, right? You like that there's infrastructure you can leverage for them to make sales phone calls, surely? The entire value of your business is basically leveraged on the fact that there's a national and global supply chain infrastructure amortized by taxpayers, socialized, and nationalized programs, right?
- mikepurvis 4y ago
  Exactly, yeah. It really is baffling how both the argument against socialized medicine and the argument for socialized road infrastructure both somehow became about freedom— one is the freedom to choose where and when and whether to get care, and the other is the freedom to go wherever you want in your personal vehicle at no cost. Or maybe it's about what you didn't pay for? Freedom is not having to have your taxes pay for someone else's surgery, but roads are a good deal as long as you drive as much as possible on them? Anyway, as a four season bike commuter and mass transit fan, it seems to me that being a slave to automobile manufacturers and oil companies and urban sprawl is the opposite of freedom, but I don't have a century of concerted propaganda on my side for that position, so most people look at me like I have three heads.
- dmitrygr 4y ago
  > Even if I put my capitalism hat on I don't understand why one would argue against socialized healthcare. Honest answer: because currently my family and I have access to above-average care at below-average wait times due to having money. This will go away necessarily due to math. So asking people who are lucky enough to be in this position to support socialized healthcare is tantamount to asking them to value the lives of randoms more than those of their family.
  - mikepurvis 4y ago
    I get this perspective, and it's no judgment on you specifically for holding it, but from my point of view as another upper middle class person, my quality of life is also improved when my neighbours have the care they need. I don't want to have to live in a gated community so that I can shut out the lepers, and that extends to things like schools too— I want a public school system that gives every kid a decent chance of succeeding and that goes the extra mile to provide supports to those who face additional challenges at home. Even at the cost of a potential opportunity for my own kid. Most of the world is not a zero sum game: the solution to scarcity is to invest and make more of it, not to fight over the scraps. “I am, somehow, less interested in the weight and convolutions of Einstein’s brain than in the near certainty that people of equal talent have lived and died in cotton fields and sweatshops.” — Stephen Jay Gould
    - AnIdiotOnTheNet 4y ago
      > I get this perspective, and it's no judgment on you specifically for holding it I'll judge them for holding it. They want the benefits of a society, then they should support that society. Otherwise the message is that they're totally ok with having a slave labor class that drives their Uber for them and picks up their take out order for them, but fuck those people when they get sick.
      - dmitrygr 4y ago
        Yes, let me clarify: Fuck everyone and everything, if it extends the life of my family member by even a day. Judge me all you want
rjh29 4y ago
Japan has an interesting approach - you have health insurance that makes everything dirt cheap, but even without insurance they don't charge ridiculous American-style prices. While on holiday I saw a doctor for 3000yen ($20) and a dentist for 4500yen ($32 incl. x-ray and meds) without any local insurance. It's actually much better than the UK for dentists at least.
refurb 4y ago
Canada is also facing massive wait times. Plenty of people can't even get a family doctor, they simply aren't taking them any more. Manitoba is sending 300 spinal surgery patients to North Dakota because they can't clear the backlog any other way. https://www.cbc.ca/news/canada/manitoba/manitoba-surgeries-north-dakota-fargo-wfpcbc-cbc-1.6319862 https://www.cbc.ca/news/canada/manitoba/manitoba-surgeries-n...
- maxehmookau 4y ago
  Sure. Under the US system, they "fix" this problem by pricing people out of the queues and they end up dying. I could reduce the demand for anything if I'm allowed to arbitrarily raise its price.
  - refurb 4y ago
    So the alternative is apparently just the government enforcing a queue to the point people can't get the surgery they need? Is that better?
    - AnIdiotOnTheNet 4y ago
      Plenty of people already aren't getting the treatment they need under the US model, only difference will be that your access to treatment is not as directly correlated to your wealth.
      - refurb 4y ago
        That's not true since the lower income bands have Medicaid which is more generous than Canadian healthcare.
        thephyber 4y ago
        > Medicaid which is more generous than Canadian healthcare You assume that Medicaid is accepted. It's increasingly difficult to find providers that will accept it. From 2015: > A 2011 nationwide survey of doctors found 31 percent were “unwilling” to accept new Medicaid patients, with acceptance rates across states varying widely. Across the nation, the study estimated 69 percent of doctors were accepting Medicaid, but state acceptance rates ranged from a low of 40 percent in New Jersey to 99 percent in Wyoming, according to the study published in Health Affairs. This was pre-ACA expansion and prior to any reimbursement fee changes.[1] > When comparing reimbursement rates among health insurance plans, Medicaid is the lowest payer, meaning it’s not a moneymaker for doctors’ offices. Paired with the administrative requirements of accepting public insurance, doctors sometimes just don’t want the hassle.[1] [1] https://health.usnews.com/health-news/health-insurance/articles/2015/05/26/youve-got-medicaid-why-cant-you-see-the-doctor https://health.usnews.com/health-news/health-insurance/artic...

jandrese 4y ago

> Free marketeers will say a fair price is what someone is willing to pay. Which is exactly why the system is broken. How much are you willing to spend to not die? Healthcare is one of those things that markets just aren't good at setting prices for. The demand curve is a wreck. I think the US has proved conclusively that a market based approach is a mistake.

SoftTalker 4y ago
> How much are you willing to spend to not die? Of course most health care is not an immediate life or death situation. Most of it is for chronic issues or routine "well care" where you would have ample time to compare prices at different providers, if there were a straightforward way to do that.
- ClumsyPilot 4y ago
  Time is an important component, but is not enough. Tere is no utility price - for example if all tv producers conspire and set TV prices at $10,000 for entry level tv i will go without one. So will all consumers. Thats your price limit. However that does not apply to medicine, see epipen scandal. prices can be inceeased infinitely. Also Many medicines enjoy patent protection and thus have no competition,
  - thephyber 4y ago
    While what you say is mostly true, it's not the whole story. Price transparency doesn't fix price fixing, broken intellectual property laws, etc. But it does increase competition in a space where opacity is currently a feature. Americans are paying so much that medical visits to other countries are affordable. Trips to Mexico or Canada to purchase medicines. Trips to Europe to get a hip replacement. The fact that "Medical tourism" even has a term means that Americans are searching for ways to reduce cost. Price transparency is a tool, even if it's debatable about how big the lever is.
- komali2 4y ago
  For non life or death things, it's still kind of, idk, what's a good economic word to describe "something you basically have to / will inevitably buy?" Your arm is broken and was put in a splint. To get the splint removed properly you gotta go back to the hospital for them to saw it off (and xray to determine it's a good time to saw the thing off). You're gonna... shop around and compare prices for this routine? I mean, you HAVE to get the splint off or your arm will rot off, plus, your quality of life is reduced with it on. "The Market" is armed with the knowledge that you've gotta get the thing off. Even with a couple hospital "options," the hospitals and insurance companies can collude (implicitly or otherwise) to charge basically whatever they want for the operation. The question isn't, what's a fair price, the question is, how much of this person's income can we extract before they'll risk cutting the thing off themselves. It seems irrational to try to justify this environment when considering the needs of the citizenry. All signs point to methods of organizing healthcare that take as much power as possible from "the market" (which just means whoever can form oligopoly), be that by having a single payer system or by simply nationalizing healthcare.

tapatio 4y ago

Or the opposite approach - stop mandating hospitals must accept any patient, regardless of their ability to pay. I bet hospitals would all of a sudden become affordable as they want to capture "low-income" market share.

Klinky 4y ago
Certain procedures are expensive & complicated regardless. Someone having a heart attack, stroke or severe COVID, would require extensive care. If you're okay letting such patients just die due to lack of funds, then this concept might work. Ethically & morally deplorable perhaps, but honest towards the goals of brutalistic capitalism.
- deleted 4y ago
  [deleted]
thephyber 4y ago
"hospitals" aren't required to do that. Only emergency rooms are[1]. The point: not all hospitals have emergency rooms. And the problem is less about what you claim (although some of the claim is valid). The core problem with required/not-required dichotomy is that cheap preventative care visits are not required, but expensive emergency care is, hence the average cost approaches the latter as people substitute the former for the latter. > In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay.[1] [1] https://www.cms.gov/regulations-and-guidance/legislation/emtala https://www.cms.gov/regulations-and-guidance/legislation/emt...

BurningFrog 4y ago

> Relying on the patient to gauge what is fair pricing & what is gouging, then haggle when they get the bill... You're making a good argument against something no one has proposed. The point of this effort is to be able to know the cost of something before you buy it. That's it! How this can "seem like another way to put blame on the patient" is pretty incomprehensible.

Klinky 4y ago
Simply put "Couldn't afford the care? Should've shopped around!". It feels like a non-solution solution to access to healthcare. In theory it's great to have transparency, but in reality this is just pushing responsibility & complexity onto patients, all to continue a facade that market-based economic models work well for patient care & will magically drive down costs.
- BurningFrog 4y ago
  I honestly don't understand your point. Do you also consider stores having price information bad? Would it be better if I went to Target, picked what I wanted, and then got a bill with the surprising cost 3 weeks later? > It feels like a non-solution solution to access to healthcare. That's correct. It addresses a different problem.
  - Klinky 4y ago
    Do you have years of medical & diagnostic coding experience along with medical training to properly interpret pricing data for a multitude of procedures with wide ranging scenarios? You're not going to Target to buy Cheerios here. Pricing transparency is a band-aid on the gaping wound that is US healthcare. More numbers to consider that may or may not apply based on your insurance policy & other factors. Let's also add some middle-men to aggregate and "find the best price".

refurb 4y ago

Disagree. The free market works great for things like Lasik surgery and cosmetic surgery. Patients shop around, get referrals, make a call and pay. The problem in the US is that's not free market. How can it be a free market if the price isn't posted or isn't known until after the purchase? How can it be a free market if people with good insurance don't care about the cost because they only pay some insignificant portion of it?

Klinky 4y ago
Why wouldn't a free market collude and monopolize to maximize profit? Idealized free markets require perfect information. Most consumers of healthcare are woefully ill informed on healthcare matters. The problem with free markets is summed up with phrases like: "caveat emptor", "a fool & his money are easily parted", "there's a sucker born every minute", "penny wise, pound foolish". Discount laser eye surgery has its own issues with deceptive advertising, misleading pricing, patients being rushed & not fully informed of potential side effects or receiving poor post-op care. People really need to research thoroughly before using a coupon for their laser eye surgery. No one should expect the market to just provide a quality product. That's foolish thinking.
- refurb 4y ago
  The free market doesn’t collide when there is competition. Just like oil cartels, they barely hold together because the first person to leave the cartel makes way more money undercutting everyone else. And many of those issues of rushing patients and not explaining risks happens in public systems too. You think doctors work for free in those systems? And in terms of quality you’d be a fool to not check even in a public system. I worked in the healthcare field and quality of doctors varies widely.
  - Klinky 4y ago
    OPEC holds huge power over global oil markets, and is not "barely held together". Com'on. Competition colluding or conglomerating is not uncommon. Much of brand competition is actually various arms of the same parent company. The illusion of competition. My point was the free market you lauded for Lasik is a mixed bag with some potentially good value for money, but also deceptive salesmen muddying the waters for consumers to make valid comparisons on price & quality. It's no panacea.