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I am trying to not take your comment personally. I understand that many medical services are not urgent. Part of the problem in the US at least is that ERs are

I am trying to not take your comment personally. I understand that many medical services are not urgent. Part of the problem in the US at least is that ERs are obligated to stabilize any patient that walks through the door, regardless of ability to pay. So you end up with people misusing the ER for chronic non urgent care. I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)

antisthenes 3y ago
In my experience, ER in the US can bill you at the highest rate pretty frivolously. I've been in the ER for "difficulty breathing", which was billed at the highest level, although still made to wait ~2 hours in waiting rooms before seeing _any_ medical professional. I've also been in the ER when brought in by an ambulance, in which case I was seen immediately. These were both billed at the highest level, when the 1st case clearly shouldn't have been.
mindslight 3y ago
Focusing on the uncommon situations needing immediate attention implied that you haven't actually dealt with the system much. If your original comment wasn't reflective of your personal experiences, then don't take it personally. When people talk about the ability to compare prices (as one can do in basically every other industry), it's nonsensical to direct focus towards the small amount of cases that require (and generally get) immediate attention, rather than the bulk of the medical system that shamelessly books appointments months away. If there were well-defined prices, it would clearly be horrible to use that fact to further cement a fiction that a contract has been created with someone under medical duress (or further justify high prices when supply is being limited by the cartel). But reforming the industry has to start somewhere, and price signals are basically the only way we've found to coordinate large scale distributed behavior - regardless of who might be paying.
- ipython 3y ago
  I’ll be honest when I don’t have an urgent issue it’s hard to layer on additional mental load to compare prices. When my wife was diagnosed with cancer, how do I realistically compare prices? What services should I ask them to quote? How do I know what to ask for? How do I realistically compare two offers? What if they left out an important part of care that the other side included? What single entity even has all the information I need? For example even for a single outpatient surgery you have to include the hospital cost, the surgeons cost, the anesthesiologist, and that’s just what I can think of off the cuff. each one of those entities has their own billing department, costs etc. so who do I call?
  - mindslight 3y ago
    You're still buying into their paradigm wherein they've created endless needless complexity to confuse the market. The entire point is that this complexity needs to be nipped in the bud with singular prices for each significant line item, just as every other industry operates. The equivalent would be when you're hungry and need to buy food at the grocery store, asking how you can manage that since you are going to have to pay for the food cost, the shelf space cost, the trucking cost, the refrigeration cost, the cashier, the bagger, etc. In actuality, the grocery store comes up with a single price that they're comfortable selling an item of food for, puts in on the shelf, and you can take it or leave it at that price. The only way the medical industry can get away with their ridiculous bullshit is seemingly through a bunch of laws they bought whereby they can saddle people with debt without actually having done the work of forming a contract. Hence why you can visit a single business, and then end up getting a slew of bills from arbitrary providers that you had no relationship to. That simply cannot happen in other industries, where the only basis for billing is having formed a contract. The equivalent for cancer is they'd lay out several treatment options (as they're already doing while ignoring prices), listing the price for each, the price and recommended frequency for followup monitoring, etc. You could then ask different providers for how much their treatment cost. Ideally the places administering treatment would be unbundled from the doctors doing the diagnosis, and the diagnosing doctors' office could give you a list of competing treatment providers. I know I'm hand waving away a lot of details here, but the whole point is that the intrinsic complexity of the problem needs to be modeled around cost, rather than treating it as an afterthought, creating a bunch of accidental complexity that ignores cost, then trying to manage it after the fact. (And note that this is still orthogonal to who is ultimately paying, whether legitimate insurance to pool risk, subsidies for those who can't pay, etc. It's easiest to see what the current system is lacking when you look at things that "insurance" doesn't cover. For example a hospital stay, I would guess most people here would pay $100/night to have a single room rather than a shared room with a roommate always setting off their bed alarm etc. But there's simply no way to express that to the system currently, creating a zero-sum environment of scarcity, rather than a positive sum environment of abundance)

antisthenes 3y ago

In my experience, ER in the US can bill you at the highest rate pretty frivolously. I've been in the ER for "difficulty breathing", which was billed at the highest level, although still made to wait ~2 hours in waiting rooms before seeing _any_ medical professional. I've also been in the ER when brought in by an ambulance, in which case I was seen immediately. These were both billed at the highest level, when the 1st case clearly shouldn't have been.

mindslight 3y ago

Focusing on the uncommon situations needing immediate attention implied that you haven't actually dealt with the system much. If your original comment wasn't reflective of your personal experiences, then don't take it personally. When people talk about the ability to compare prices (as one can do in basically every other industry), it's nonsensical to direct focus towards the small amount of cases that require (and generally get) immediate attention, rather than the bulk of the medical system that shamelessly books appointments months away. If there were well-defined prices, it would clearly be horrible to use that fact to further cement a fiction that a contract has been created with someone under medical duress (or further justify high prices when supply is being limited by the cartel). But reforming the industry has to start somewhere, and price signals are basically the only way we've found to coordinate large scale distributed behavior - regardless of who might be paying.

ipython 3y ago
I’ll be honest when I don’t have an urgent issue it’s hard to layer on additional mental load to compare prices. When my wife was diagnosed with cancer, how do I realistically compare prices? What services should I ask them to quote? How do I know what to ask for? How do I realistically compare two offers? What if they left out an important part of care that the other side included? What single entity even has all the information I need? For example even for a single outpatient surgery you have to include the hospital cost, the surgeons cost, the anesthesiologist, and that’s just what I can think of off the cuff. each one of those entities has their own billing department, costs etc. so who do I call?
- mindslight 3y ago
  You're still buying into their paradigm wherein they've created endless needless complexity to confuse the market. The entire point is that this complexity needs to be nipped in the bud with singular prices for each significant line item, just as every other industry operates. The equivalent would be when you're hungry and need to buy food at the grocery store, asking how you can manage that since you are going to have to pay for the food cost, the shelf space cost, the trucking cost, the refrigeration cost, the cashier, the bagger, etc. In actuality, the grocery store comes up with a single price that they're comfortable selling an item of food for, puts in on the shelf, and you can take it or leave it at that price. The only way the medical industry can get away with their ridiculous bullshit is seemingly through a bunch of laws they bought whereby they can saddle people with debt without actually having done the work of forming a contract. Hence why you can visit a single business, and then end up getting a slew of bills from arbitrary providers that you had no relationship to. That simply cannot happen in other industries, where the only basis for billing is having formed a contract. The equivalent for cancer is they'd lay out several treatment options (as they're already doing while ignoring prices), listing the price for each, the price and recommended frequency for followup monitoring, etc. You could then ask different providers for how much their treatment cost. Ideally the places administering treatment would be unbundled from the doctors doing the diagnosis, and the diagnosing doctors' office could give you a list of competing treatment providers. I know I'm hand waving away a lot of details here, but the whole point is that the intrinsic complexity of the problem needs to be modeled around cost, rather than treating it as an afterthought, creating a bunch of accidental complexity that ignores cost, then trying to manage it after the fact. (And note that this is still orthogonal to who is ultimately paying, whether legitimate insurance to pool risk, subsidies for those who can't pay, etc. It's easiest to see what the current system is lacking when you look at things that "insurance" doesn't cover. For example a hospital stay, I would guess most people here would pay $100/night to have a single room rather than a shared room with a roommate always setting off their bed alarm etc. But there's simply no way to express that to the system currently, creating a zero-sum environment of scarcity, rather than a positive sum environment of abundance)