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> So there's no way to tell the patient beforehand that their care will cost x amount. I call B.S. -- unless you're calling B.S. on the data. There's somethin

> So there's no way to tell the patient beforehand that their care will cost x amount. I call B.S. -- unless you're calling B.S. on the data. There's something called "estimation" which comes in very handy when you don't know something with certainty. If you have absolutely no idea, then you just guess the average cost for each patient with a similar background, with a disclaimer that it may not be accurate. Problem solved, unless you don't want to do it because then it'll prevent you from ramping up the prices unnecessarily later.

jaynos 13y ago
Tell me my surgery will cost $100,000 at hospital X and $200,000 at hospital Y (both of which are close to me and staffed with competent employees). It won't influence my decision as long as my insurance company doesn't care. I'll pick based on the doctor and the insurance company can negotiate either bill (down to a very similar level, I presume). If I don't have insurance, I may be swayed by the $100,000 price, but either way they'll have to sue me to get all of the money that they ask for.
wpietri 13y ago
Problem definitely not solved. There's too much uncertainty, and comparisons are too hard. This happens all the time in software. Non-techies put a project out for bid. They will get estimates from a variety of consulting companies. The estimates could easily vary by an order of magnitude. Do they go with the lowest, because they are the most efficient operation? Or is the low price a sign that they're the dumbest, and are underestimating? Do they go with the highest, because in a market economy price is correlated with value? Or are those guys just the gougers? And medicine is worse, because things are so contingent. Complications get complicated indeed. And the person trying to make the decision is pretty likely to be sick. I tell you true: deciding what to do about cancer is hard enough without trying to organize and judge a multi-round competitive bidding process.
- wfunction 13y ago
  Claiming something is "too hard" never got anyone anywhere.
  - wpietri 13y ago
    Neither did waving away problems as if they didn't exist. If you can solve this, solve it. But arguments of the form "in theory there's a solution, so problem solved" aren't a step forward; they're a way to prevent others from trying.
    - wfunction 13y ago
      > they're a way to prevent others from trying. What exactly was I trying to prevent others from trying?
      - wpietri 13y ago
        Well, I was assuming that you were participating in the conversation, rather than just seizing upon a sentence and nitpicking. The conversation was about the role of the free market in health care. User curt said that the only way to solve health care pricing was through the free market via individual choices. Mikeash said that would only work if we were happy to let people die of treatable diseases. Anonymoushn said that was a distraction, that the market would be fine if people could know prices up front. Grey-area said that predicting costs was basically impossible, so the market-based solution was unworkable. You jumped in to say that prices were predictable through this new thing we hadn't heard of called "estimation", saying that this solved the problem. The problem, presumably, being how price opacity and unpredictability make a hash of individual-choice market mechanisms. So I have no idea what you were trying to do, but as far as I can tell, it was either a) pushing people back toward an unworkable market-based solution for health care, thus preventing them from moving toward a solution that doesn't fit with the fundamentalist liberarian ethos so popular on HN, or b) you're doing this: http://xkcd.com/793/ http://xkcd.com/793/. Given that you ignored the meat of my point twice in a row with nitpicky comments, as well as doing the same to the previous poster, I'm figuring b.
artsrc 13y ago
Alternatively just charge everyone the average cost, with no disclaimer. In fact you can do that before the need for care is even known, and you can call it insurance.

jaynos 13y ago

Tell me my surgery will cost $100,000 at hospital X and $200,000 at hospital Y (both of which are close to me and staffed with competent employees). It won't influence my decision as long as my insurance company doesn't care. I'll pick based on the doctor and the insurance company can negotiate either bill (down to a very similar level, I presume). If I don't have insurance, I may be swayed by the $100,000 price, but either way they'll have to sue me to get all of the money that they ask for.

wpietri 13y ago

Problem definitely not solved. There's too much uncertainty, and comparisons are too hard. This happens all the time in software. Non-techies put a project out for bid. They will get estimates from a variety of consulting companies. The estimates could easily vary by an order of magnitude. Do they go with the lowest, because they are the most efficient operation? Or is the low price a sign that they're the dumbest, and are underestimating? Do they go with the highest, because in a market economy price is correlated with value? Or are those guys just the gougers? And medicine is worse, because things are so contingent. Complications get complicated indeed. And the person trying to make the decision is pretty likely to be sick. I tell you true: deciding what to do about cancer is hard enough without trying to organize and judge a multi-round competitive bidding process.

wfunction 13y ago
Claiming something is "too hard" never got anyone anywhere.
- wpietri 13y ago
  Neither did waving away problems as if they didn't exist. If you can solve this, solve it. But arguments of the form "in theory there's a solution, so problem solved" aren't a step forward; they're a way to prevent others from trying.
  - wfunction 13y ago
    > they're a way to prevent others from trying. What exactly was I trying to prevent others from trying?
    - wpietri 13y ago
      Well, I was assuming that you were participating in the conversation, rather than just seizing upon a sentence and nitpicking. The conversation was about the role of the free market in health care. User curt said that the only way to solve health care pricing was through the free market via individual choices. Mikeash said that would only work if we were happy to let people die of treatable diseases. Anonymoushn said that was a distraction, that the market would be fine if people could know prices up front. Grey-area said that predicting costs was basically impossible, so the market-based solution was unworkable. You jumped in to say that prices were predictable through this new thing we hadn't heard of called "estimation", saying that this solved the problem. The problem, presumably, being how price opacity and unpredictability make a hash of individual-choice market mechanisms. So I have no idea what you were trying to do, but as far as I can tell, it was either a) pushing people back toward an unworkable market-based solution for health care, thus preventing them from moving toward a solution that doesn't fit with the fundamentalist liberarian ethos so popular on HN, or b) you're doing this: http://xkcd.com/793/ http://xkcd.com/793/. Given that you ignored the meat of my point twice in a row with nitpicky comments, as well as doing the same to the previous poster, I'm figuring b.

artsrc 13y ago

Alternatively just charge everyone the average cost, with no disclaimer. In fact you can do that before the need for care is even known, and you can call it insurance.