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I love what you say, but how does one realistically implement this today? I can’t exactly call up a hospital and say “cut the bullshit. I need a single price fo

I love what you say, but how does one realistically implement this today? I can’t exactly call up a hospital and say “cut the bullshit. I need a single price for procedure x”. They’ll just laugh and hang up the phone. (I’ve tried- most recently for a vasectomy). As you say, the industry is fat and happy and has no reason to bend to my will no matter how much sense it makes in the long run. My point is that we have a whole bunch of policy nerds hand waving this complexity away and saying “enjoy your hsa- go forth and price compare as the invisible hand of the free market will provide!” Unless there is force from above, there certainly is no way the masses can navigate the system and force change themselves. And the truth is that stuff does happen that’s not anticipated. My wife’s surgery was supposed to be routine. I would have had no idea ahead of time that there would be a lingering internal infection afterward. Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”. If a tradesman screwed up a plumbing job, he would be called back to fix it at no cost. Instead I’m (or in this case my insurance) is stuck with >$100k of bills from the ICU to bring her back from the brink. I consulted with several malpractice attorneys who basically said unless the surgeon was drunk and slurring his words while operating, there is no case. The standard of care is so low.

mindslight 3y ago
I'm definitely not hand waving away regulatory things that need to change to make things sensible, especially in a way that doesn't just bless the current corrupt system with a new veneer of justification. High level points, from what I can tell - 1. The laws/regulations enabling the current system/cartel need to be scrapped. This includes the ability for providers to unilaterally assign arbitrary debts to patients, and the regulations enshrining the existence of HMOs (I assume these exist because HMO "networks" look exactly like what an 80's Coase fallacy drunkard would think constitutes competition) 2. New regulation / anti-trust enforcement needs to be applied to providers, such that they must publish clear prices for standard services that are comparable across providers, and straightforward hourly rates for anything that cannot be captured on there (with any nonconforming bills being considered attempted fraud). 3. New regulation / anti-trust enforcement needs to be applied to insurance companies, outlawing "provider networks" and rephrasing all insurance coverages purely in terms of prices, applying to any medical service from any licensed medical provider. That parallel "medically necessary" approval system needs to be entirely eliminated. > Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”... The standard of care is so low Routinely experiencing that dynamic of poor care [0] from the medical industry is exactly what makes me shake my head at the simplistic "fix it by having the government take it over" narrative. Ballooning costs and individual ability to pay is a problem, yes. But the much larger problem is the utter waste of medical talent, because the system has been designed around terms of top-down paperwork-filling rather than responsiveness to patients. The doctor should have been working for you, and you should have been able to get more time/attention for the doctor to have taken you seriously. But that was impossible because the "insurance" company dictated that you got one tiny follow up appointment, with the doctor focusing on filling his seat during that appointment, doing the bare minimum that conforms to the top-down standard of care, and avoiding doing anything extra that might create legal liability. [0] Although not as much malpractice and completely avoidable as yours. I'm sorry for what you both went through.

mindslight 3y ago

I'm definitely not hand waving away regulatory things that need to change to make things sensible, especially in a way that doesn't just bless the current corrupt system with a new veneer of justification. High level points, from what I can tell - 1. The laws/regulations enabling the current system/cartel need to be scrapped. This includes the ability for providers to unilaterally assign arbitrary debts to patients, and the regulations enshrining the existence of HMOs (I assume these exist because HMO "networks" look exactly like what an 80's Coase fallacy drunkard would think constitutes competition) 2. New regulation / anti-trust enforcement needs to be applied to providers, such that they must publish clear prices for standard services that are comparable across providers, and straightforward hourly rates for anything that cannot be captured on there (with any nonconforming bills being considered attempted fraud). 3. New regulation / anti-trust enforcement needs to be applied to insurance companies, outlawing "provider networks" and rephrasing all insurance coverages purely in terms of prices, applying to any medical service from any licensed medical provider. That parallel "medically necessary" approval system needs to be entirely eliminated. > Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”... The standard of care is so low Routinely experiencing that dynamic of poor care [0] from the medical industry is exactly what makes me shake my head at the simplistic "fix it by having the government take it over" narrative. Ballooning costs and individual ability to pay is a problem, yes. But the much larger problem is the utter waste of medical talent, because the system has been designed around terms of top-down paperwork-filling rather than responsiveness to patients. The doctor should have been working for you, and you should have been able to get more time/attention for the doctor to have taken you seriously. But that was impossible because the "insurance" company dictated that you got one tiny follow up appointment, with the doctor focusing on filling his seat during that appointment, doing the bare minimum that conforms to the top-down standard of care, and avoiding doing anything extra that might create legal liability. [0] Although not as much malpractice and completely avoidable as yours. I'm sorry for what you both went through.