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What Happens When Doctors Only Take Cash (2017)

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Re: What Happens When Doctors Only Take Cash (2017)

#111

Post by laretluval »

conanbatt wrote: post #107
rocketpastsix wrote: post #104

Earlier quoted context omitted.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

> ate the cost. If they ate the cost, someone else paid for it. Which means that prices in general take this into account. I'm not judging OP, but saying that the ability to apply that technique is not= the solution to the general problem. (Healthcare is expensive).

It's likely that the cost was nowhere near $12000. These huge bills are often the result of runaway price inflation and system-gaming and are totally untethered from cost.

Re: What Happens When Doctors Only Take Cash (2017)

#112

Post by killjoywashere »

rvail2 wrote: post #64
killjoywashere wrote: post #30

This whole thread is full of young, SV libertarians who haven't really thought out what healthcare involves. Lawyers don't have an upfront, all inclusive price for divorce, they charge by the hour. I'm pretty sure software developers charge by the hour, at least for the interesting work. Sure, I'll build you a Wordpress blog for $3k. Would you gaurantee you could build a clinic website that supports major insurance a…

What about a dermatologist? An appointment has a set fee. If you need treatment for something out of the ordinary, they give you options and prices. Then, you get to decide on how you proceed. Seems pretty simple.

Have you seen a dermatology textbook? They're the thickest books on my shelf. And as a pathologist, I'm only seeing the stuff that merits "I'm not exactly sure what to do here, let's get a biopsy and see if that provides us more information."

Then I, as the pathologist, provide some hedgy answer that's not in the textbook, because the patient's disease didn't read the textbook. And we have to jam that all into CPT codes, SNOMED codes, LOINC codes, ICD9 and ICD10 codes, complete with conversions between major and minor releases of those code lists, etc, etc.

Re: What Happens When Doctors Only Take Cash (2017)

#113

Post by killjoywashere »

Turing_Machine wrote: post #91
killjoywashere wrote: post #30

This whole thread is full of young, SV libertarians who haven't really thought out what healthcare involves. Lawyers don't have an upfront, all inclusive price for divorce, they charge by the hour. I'm pretty sure software developers charge by the hour, at least for the interesting work. Sure, I'll build you a Wordpress blog for $3k. Would you gaurantee you could build a clinic website that supports major insurance a…

> Orthopods might be able to replace knees on a fixed budget, but I'm thinking neurosurgeons and trauma surgeons would have a heckuva time. Why would they? That's basically how existing insurance companies work, dude -- they typically pay doctors a specific amount for a specific procedure. > This whole thread is full of young, SV libertarians who haven't really thought out what healthcare involves. In my youth, I wor…

> they typically pay doctors a specific amount for a specific procedure.

No, they only pay specific amounts for specific procedures.

> In my youth, I worked in a drug store

Do you realize pharma is only 10% of the problem?

Re: What Happens When Doctors Only Take Cash (2017)

#114

Post by conanbatt »

verbatim wrote: post #110
conanbatt wrote: post #107

Earlier quoted context omitted.

> ate the cost. If they ate the cost, someone else paid for it. Which means that prices in general take this into account. I'm not judging OP, but saying that the ability to apply that technique is not= the solution to the general problem. (Healthcare is expensive).

Your assumption that "someone else paid for it" only holds if the price was directly tied to external costs and not their own profit.

So you say investors pay for it? Very generous on their behalf.

Re: What Happens When Doctors Only Take Cash (2017)

#115

Post by Agathos »

mikestew wrote: post #72
friedButter wrote: post #41

Earlier quoted context omitted.

>My local mechanic is required by law to tell me how much something is going to cost me before they start work. Why is my doctor not held to the same standard. Ever tried calling a provider to find out how much something is going to cost? Does that include a situation where say, when emptying out the oil, the nut over the drain breaks off which necessitates changing the oil sump, except they then discover the engine…

I'll let an ex-mechanic answer: me. In that situation the service writer (my go between me and the customer) calls the customer and tells them what is needed. If they don't want to do it, button it up and send them on their way. In your made-up example, there are fixes for a stripped drain plug that don't require dropping the oil pan. If it weren't for Jiffy Lube (who, more than once, stripped it before it got to me)…

People leap straight for the heart surgery example as if to imply it justifies the lack of price transparency for routine medical procedures where the patient is fully conscious. Why is that?

Re: What Happens When Doctors Only Take Cash (2017)

#116

Post by DoreenMichele »

killjoywashere wrote: post #109
Turing_Machine wrote: post #102

Earlier quoted context omitted.

Every insurance company in the United States, along with Medicare and Medicaid, already has a fixed amount that they will pay the caregiver for administration of TPA. I guarantee it, even without bothering to look up what TPA is. If the procedure is covered by insurance at all , there's a pre-approved reimbursement amount for doing it. Outside of an expensive, time-consuming, and almost always useless appeals process…

I get that. Do you know the history of the CMS billing schedules? They called Dr. DeBakey and he sent a couple of his fellows to Washinton and they priced out every single thing. That has been revised, amended, and addended many times since, but yes, I'm well aware. The point is that there's no shopping around in the emergent cases. You can't say "Well, in my incapacitated, mid-stroke state, let me check the menu of…

Your point is irrelevant to whether or not pricing transparency has value for customers. It's like saying that it doesn't matter at all if mechanics provide pricing transparency because you could break down in the middle of nowhere in the desert somewhere, and then what good does that do you?

Re: What Happens When Doctors Only Take Cash (2017)

#117

Post by killjoywashere »

maxxxxx wrote: post #39
killjoywashere wrote: post #23

Earlier quoted context omitted.

Should software developers and lawyers also have upfront pricelists for all services? I will gladly develop a cure for cancer, for the low, low price of $20B.

When I hire a software developer or a lawyer I get an upfront price list. Would you hire a lawyer that either would not give you any price or told you "it costs between 2000 and 60000 depending on your insurance and some other factors we won't tell you"?

The difference is law, software, car repair, home remodels, etc, are all man-made systems. Medicine is dealing with a system that I think we can all agree man did not make.

Re: What Happens When Doctors Only Take Cash (2017)

#118

Post by conanbatt »

digi_owl wrote: post #105
rocketpastsix wrote: post #104

Earlier quoted context omitted.

Most likely, they just adjusted the price down to what the Patients Bill of Rights said, and ate the cost. Or pushed it onto tax payers somehow.

I recall encountering the claim that hospitals will mark up the initial bill because they are used to dealing with insurance companies, and said companies will turn over very stone possible to drive the price down. Thus the markup is done to ensure the hospital get their expenses covered after the insurance companies are done with them.

Even if that is true, a company will be successful in the degree they can do this more than the other companies in the same space. I don't think laws like this effectively lower the cost, because first of all, a good chunk goes to lawyers and patient advocates.

Also as the system gets itself more expensive, the mechanics that make it more expensive can also become more worthwhile! Its a spiraling costs issue.

Man healthcare in the U.S. is so broken.

Re: What Happens When Doctors Only Take Cash (2017)

#119

Post by laretluval »

qubex wrote: post #21

> Setting and casting a basic leg Oh good God, I’d never thought of this... I’ve broken more bones than I care to count (wrist, triple torsion fracture in my ankle, two ribs twice, shoulder) and I’ve never paid a penny (here in Italy). I’d never even remotely contemplated it might be a cost beyond the annoyance.

Access to free healthcare does not result in better health outcomes, at least in the US.

http://www.overcomingbias.com/2007/05/rand_health_ins.html

Re: What Happens When Doctors Only Take Cash (2017)

#120

Post by semperdark »

noobhacker wrote: post #84
conanbatt wrote: post #62

Earlier quoted context omitted.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

The high health care cost is due to a lot of unnecessary procedures being performed. This can happen in two ways. First, there are a lot of tests and procedures ordered by doctors that only have some, but very small, benefits for the patients [0]. Doctors are incentivized to do this because each procedure has a set price (negotiated with insurance companies and Medicare / Medicaid) and the only way to get more revenu…

Third, doctors order unnecessary but "by-the-book" tests to document things that they already know in case of a malpractice lawsuit.

https://en.wikipedia.org/wiki/Defensive_medicine

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