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User Info The Bill To Fix Health Care - Permanently; entered at 2017-03-30 12:56:40
Posts: 148485
Registered: 2007-06-26
There's several serious problems with some of these ideas. For one, as a Dentist, I know that many times the exact problem I face when trying to restore a tooth can't be determined until the procedure is well under way. To mandate that the cost is exactly known before treatment starts is only going to increase the cost of every thing done to cover the numerous times things are more complex and expensive to care for. Ditto for covering stuff that requires additional treatment.

The car dealer doesn't know exactly what he faces when the customer comes in with bad brakes either. He prices the procedure at a price that allows him to make money on an average basis. On any particular car he may make more, less or even lose money, but on average he's ok. That's what a flat-rate book does. "Replace rear brakes: $400."

For example some percentage of the time when you reset a brake caliper the seals will fail. There's no way to know in advance whether they will or won't, but if they do then you have to replace the caliper with a rebuilt one and send the old one out for a rebuild. That's an additional expense, but guess what -- the price for a set of brakes on an axle might well INCLUDE that possibility. If it doesn't then the dealer has to DISCLOSE THAT and say "well, if the caliper is bad the additional charge will be $X."

Why can I beat the dealer VIRTUALLY EVERY TIME doing that job myself? Because I flush my brake fluid every 2 years and thus I've yet to have to replace a caliper! But.... most drivers do not. Same thing with slider pins and seals; they may need replacement, they may not. You won't know until you take the brakes apart. Nonetheless the dealer's price includes that possibility, and he uses statistical data to set that price. He may win or lose on any one brake job but across all of them he makes a fair profit.

If you go to an independent shop you may get a quote that looks something like this:

1. R&R brakes including pads and rotors: $150.
2. IF NEEDED, caliper, rebuilt: $50 (each)
3. IF NEEDED, slider pins and seals: $10 (each)

There's nothing wrong with that sort of quote.

What's ILLEGAL is to REFUSE provide a price until AFTER the customer's car is on the rack and the brakes are off. Now he CAN'T tell you to go **** a duck. You wish to protect that model, yet it's BLATANTLY ILLEGAL under both state and federal consumer protection law. Car dealers and repair shops used to do this all the time, which is why those laws were passed. They did a lot of "fixing" things that weren't broken -- or which THEY broke -- too.

As another direct example of this the VW ALH TDI flat-rate book quotes 4 hours of labor to R&R an alternator. I can get one out of a car that has not been in the rust belt (like the one my kid now owns) and back in within an hour, for 1/4 of the time the dealer charges to do the job and I don't own a lift -- I have to do the job on ramps, which is a far bigger pain in the ass. I beat the dealer's time because I can get it out without having to remove the front clip first; I can take it out from the bottom.

BUT, if the bolts are frozen then that won't work because I can't get the tools I need to break them free into where they need to go (or worse, grind them off) without doing it "by the book." Apparently a fairly high percentage of these cars DO have that problem, but certainly not all. Am I getting ripped off if I take MY car to the dealer to change an alternator? No, that's his price. If I don't like his price I can find an independent shop that charges some other price or I can do it myself. It's called COMPETITION.

Medicine is no different. Some customers who present with a particular issue will be easy, some harder. Sometimes you will run into unexpected problems, sometimes you won't.

Further and at least as importantly, dentists vary in their skill level. Some dentists meet the minimum requirements, some are better, and some are REALLY good. The really good ones might be able to manage to pull off a less-involved restoration a greater percentage of the time successfully. Well, guess what -- that means their cost of the procedure is lower on average and thus the price they choose to charge might be cheaper!

More to the point if you're just an AVERAGE dentist then why should the CUSTOMER pay for your inability to complete the job without him getting a "surprise"?

Is YOUR skill (or lack thereof) HIS problem? No, but at present you DEMAND that it be that way. If YOUR inability to complete a restoration in a minimal way is due to YOUR relative skill level THE CUSTOMER PAYS FOR IT BUT DOESN'T KNOW THAT WAS THE CASE UNTIL ITS TOO LATE TO CHANGE HIS MIND AND GO SOMEWHERE ELSE.

If you are forced to price by procedure and itemize then YOUR price will be HIGHER than the dentist who is of higher skill IF said higher-skilled dentist can complete the procedure a greater percentage of the time WHILE DOING LESS. And guess what -- you'll lose customers! That's good for the customer, who has LESS work done to his teeth AND HE SPENDS LESS MONEY ON TOP OF IT.

What's wrong with a price list like this?
1. Investigation of restoration: $50 (findings to customer)
2a. Completion of basic restoration on recommendation from 1: $50
2b. Completion of cap/crown on recommendation from 1: $450

Nothing! Except..... you as the skilled practitioner get to set the price AND TAKE THE RISK WHEN YOUR RECOMMENDATION IS WRONG. The customer doesn't know which is why he's in the chair -- you are holding yourself out as the EXPERT. If you're wrong a large percentage of the time on the "basic" restoration you're going to either have to up your "basic" price (a lot) or get hammered and go out of business. The guy down the street WHO IS BETTER AT IT THAN YOU, on the other hand, can price HIS restoration work LOWER for the basic case because he is wrong less-often. In other words he's the better expert and he takes your customers away as a result.

That's what competition DOES. It forces you to get better or you lose customers because you cannot compete with the guy across town and eventually your practice closes! That's GOOD, not BAD -- for everyone EXCEPT you.

Can you adjust pricing for time in high demand? Sure, but you can't charge a different person a different price for service of like kind and quantity. So if you find that MOST people want AM appointments you can have a note on your price list that says "10% discount for appointments between 3-4PM." If you're willing to get out of bed at 3:00 AM for the guy with an abscess, but are going to charge him double for that, as long as it's in your price list so the customer can shop and decide on his own whether it's worth the extra money it's legal. Let the customer decide; how much is the convenience worth? That's perfectly fair, reasonable AND LEGAL under this bill, just like it is for the A/C guy who you want to come out and fix your air conditioner at 3:00 AM on July 4th.

Last modified: 2017-03-30 13:16:33 by tickerguy

2017-03-30 12:56:40