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User Info The Bill To Fix Health Care - Permanently; entered at 2017-04-01 06:38:15
Posts: 203729
Registered: 2007-06-26
"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.""
Two problems with this simile.
1. The human body and it's physiological mechanisms are vastly more complicated than a brake job.

That's true. Now how many nice old ladies come into the auto shop and say "It's making a noise and I don't know what it is. Fix it."

Lots. And the way this USED to be handled was that the old lady got fucked. The car went on the rack and when it was done, well, she got the bill. And maybe it was fair, but often it was not. Maybe the ball joints weren't really bad or maybe the shop owner just saw $$$ in her eyes.

The media got onto it and starting doing exposes. They found some little old ladies, gave them a car with a KNOWN problem that a master mechanic had already diagnosed and had them go to the shop with it. They came back with bills for 5 or 10x that much and a lot of work done that wasn't needed. Repeatedly and reliably.

The laws changed. The car dealers all said they'd go out of business if the law changed because "cars are complex and when someone doesn't know what's wrong we can't possibly know if it's a minor thing that's loose or the engine's bad and needs to be replaced."

All that's gone now. Guess what? They dealt with it. What's wrong with a diagnostic charge, then presenting the customer with what's wrong and the cost to fix it?

Nothing. Except you don't like that model in medicine, because you can't assrape the customer any more. If you have to quote prices and give the customer a diagnosis and cost then you still get to charge for the diagnosis but now the customer chooses what to do and where. He or she decides that procedure may need to be done but guess what -- the doc or hospital across town will do it for less. This nasty thing called COMPETITION comes into the game, and the better doctor fucks up less often too.

That means he EATS FEWER OF HIS OWN MISTAKES, as does the hospital that does a better job of controlling infection and other errors -- like giving you the wrong drug, or the wrong dose. Quality in execution makes for more efficiency and, as a result, LOWER COST. That's reflected in PRICE. The better doctor wins -- he gets more business and he keeps more of what he makes. The poorer doctor LOSES -- and ultimately, maybe he sweeps floors.

That's GOOD, not bad. But boy, you don't like it.

Neither did the crooked car repair shops.

Tough shit. Either stop this crap voluntarily or the system will collapse and you'll get nothing. Worse, the people might eat you since you caused it, if they figure it out.
2. As one poster already pointed out sometimes you don't know what you have to fix until you start trying to fix it. Now in a brake job the maximum risk the shop takes is limited to the entire brake system. Say a five to six multiple of the repair cost. In medicine the maximum risk under this scenario is thousands fold for expensive specialty or rehabilitative treatment or even chemotherapy. Basically now the doctor has to take out insurance to cover his downside risk of catastrophic losses, not just malpractice.

Oh bullshit.

Look, there's nothing wrong with separating diagnostics (cheap) from fixes (maybe really expensive.) But again, you don't want to do it.

Why not? That's pretty simple to figure out -- if you have to separate the diagnostics from the fixes then the customer gets to choose. Not only does he or she choose what to do (which means it's on him or her instead of you if he chooses "no") but it ALSO means you get stuck with the cost of being wrong -- which might be REAL BIG, since you can't hide the wrong any more. For the good doctors -- the ones who can actually nail a diagnosis -- this is a great thing. They figure out how to diagnose at a lower cost, and they win big by getting more business. The customer wins by saving money on that part of it. The customer then picks where and by whom they wish to fix it, if it's fixable at all, and if there's a menu of possible treatment options they get to pick that too. Their choice, their cost and, even better, they get the responsibility for the outcome if they pick choice #1 over #2.

See, medicine isn't an exact science. That's why you call it "practicing" -- which I'm sure you know. Well, you're practicing on me! Since I have to live with both the successes and the fuckups when you practice, and you specifically deny that you can control outcomes then I insist that you provide me with your "best guess" AND the price to fix whatever you find BEFORE YOU DO IT. I also want to know how many times you've done this before and what the outcomes were -- how often were you right, how often wrong, and what sort of success record do you have in correcting it.

Since it's MY ass and not yours on the line I want to think about it -- not only to evaluate your record of accuracy and success, but your quoted price. I want to compare that with the clinic across town, on the other side of the state, or, for that matter, in India! And then I'm going to choose. My choice, my money, MY ASS.

If you're good at what you do then you don't fear this sort of thing. You're one of the docs who will win. But if you suck, well, you fear this greatly. Your failures will be exposed. Your record of failure will be on the table and you won't be able to hide it any more. And you soon won't be a doctor -- not because you get sued out of existence, but because you won't have any customers.

Well, guess what -- either do things this way or the system collapses. How much do you make when there's no government backing of the money at all because it can't fund itself, interest rates are 20% for 1 year money and nobody has any to pay you wish?
You are asking the doctors to self insure, but they are doctors not insurance companies. You have now created another insurance product and you still haven't gotten rid of the first one. What if the patient dies during the procedure? Shortly there after? They do. This was not "the expected outcome" but it happens. Are you going to ask the doctor to cover the burial cost? Replacement of lost wages? Your proposal now requires the doctor to take a life insurance policy out on the patient.
Horseshit top to bottom. You didn't read the ENTIRE SECTION on defensive medicine stoppage. Why? Was that intentional? I'll take the retraction and apology now, that is if you'd like to hang around here beyond, oh, maybe noon today.

What's worse is that all this was laid out in the original post and you intentionally ignored all of it. The fact that separating diagnostics from fixes will become necessary. That exposing data to the customer on the success rate will both drive down cost and favor the better physician -- he'll have a cheaper cost of operation AND a better success rate, and thus will gain customers while the poor physician will lose them and either have to up his game or go out of business. Further, putting the decision and cost for treatment options in front of the customer BEFORE the work is done means the person who's ass is on the line will be the one making the decision as a matter of informed consent instead of being treated as a rube who knows nothing and simply is expected to pay whatever bill is presented AFTER THE FACT, whether that was the best option available to him or her or not.
I am not a surgeon but I have tremendous respect for what their training, devotion and work entails. Do you want a doctor or a mechanic when you are ill?
Carl's treatise on this issue is the best yet. The healthcare discussion is really one about how to take a service industry that has been granted/earned a level of monopoly and make it competitive when it doesn't want to be competitive. Right now the insurance companies are the levered players not the doctors. If you socialize it, and that's what we are doing now by choking regulation and wealth redistribution in the form of a multi tiered charge structures, you will not have doctors because they wont be able to pay back their $300,000 loans. And it's not just the doctors and the health insurance companies. Americans are over utilizers compared to the rest of the world. We are soft, fat and unhappy. Very complex problem. But if you don't have good doctors you have nothing. Communism proved that.

Why's it cost $300,000 to be a doctor? Do you really think that's anything close to a reasonable cost to learn the trade? What if you suck? Are you still entitled to the $300,000?

How come it didn't cost $300,000 (in today's money) in the 1960s to become a doctor? Did the human genome magically change to something 100x more complex? Or did you just start fucking people in the ass, starting with an entitled mentality drilled into your head in medical school?

You sound an awful lot like the snowflake that takes out $150,000 in debt to learn....... painting. Or.... sociology. And then, of course, they're ENTITLED to a job that pays that amount. Nobody ever expects them to justify their decision to do something stupid, nor their willful and intentional support (by attending and agreeing to pay!) for a racketeering enterprise at said "college". Nobody ever expects said "student" to ask "what the hell do you think you're doing charging that sort of money for this educational experience, and how do you think it's ever going to get paid back -- without me extorting someone else?"

No, there's no responsibility there! You're all Marcus Welby!


Last modified: 2017-04-01 07:26:54 by tickerguy

2017-04-01 06:38:15