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Culture War Roundup for the week of December 2, 2024

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I'll take your silence to be an admission that you can inform your patient before you take other actions.

You can provide your patient the information that you have, as we have discussed over and over again.

The prices have no relationship with what the patient pays. Why do you not understand this? What is so hard to understand about that?

See above.

I didn't answer your other statement because it was incorrect and misunderstands how this works.

We have already agreed that you have pieces of information that can be useful. It was very long ago at this point. Just give them the information that you have.

On the other bit, you're going to have to give me a reason why you can't inform your patient before you take other actions, because so far, a lot of your stated reasons for things have been somewhere between bizarre and bollocks, so I'm definitely not going to accept a completely unstated reason.

I said the price of apples has value.

The prices of oranges has no value, especially when you are actually buying whole wheat pasta.

You want me to hire an orange consultant to teach someone about oranges but we are giving them pasta.

Hiring an orange consultant isn't free, and will lead to people being confused when they end up eating sauceless pasta instead of an orange.

You don't need to hire a consultant to inform your patient about the charge that you will be billing their insurance or the negotiated rate. Apples/oranges/whole wheat pasta is another bizarre thing that appears to have no relevance to the question at hand. You have the information we've been talking about. You can just inform your patient. You can do it before you take further action that would generate such a charge. It would be unethical to do otherwise.

The information a patient needs to make a decision is whole wheat pasta, but you are demanding that I give them information about oranges.

This is the problem.

Patients want to know what they will pay. This is whole wheat pasta. Insurance is in charge of whole wheat pasta. Whole wheat pasta is what the patient gets.

Oranges are what you are asking for. Oranges have little relationship with whole wheat pasta other than they are food. What the insurance company does to turn oranges into whole wheat pasta is mostly nonsense and depending on the thing may be literally 100% unrelated. Knowing about oranges tells you little to nothing about whole wheat pasta.

For this reason oranges are not my job. I do know about some oranges, there are other oranges I know nothing about, because oranges are never relevant to the patient.

Informed consent implies information, information about oranges does not enhance knowledge of whole wheat pasta. Patients are getting whole wheat pasta, not oranges.

Furthermore, gathering information about oranges (which are not whole wheat pasta) is not free. You are asking me to spend time and money on oranges while the patient is getting whole wheat pasta.

This would have the impact of increasing the price of whole wheat pasta without improving its quality. The patient would still not get oranges.

Now the patient is confused! Why did you tell me about oranges? I got whole wheat pasta instead.

Because some random person on the internet insisted I tell you about oranges despite the fact that you were getting whole wheat pasta.

Patients want to know what they will pay

You're ignoring what I've written time and time again. I am asking you to simply inform your patient about the charge you are going to submit to their insurance and the negotiated rate. That is information that can be useful. You are correct that it is not an exact description of exactly what they will pay out of pocket. There are also deductibles, co-insurance, out-of-pocket max, etc. That's not to do with you; that's why you're not telling them those other things. You're telling them the information that you have - the charge that you are going to submit to their insurance and the negotiated rate. You have this information. You can tell them. Just tell them.

My hospital charges three oranges, a second hospital charges two oranges, a third hospital charges four oranges. Your insurance gives all three hospitals a single banana. Regardless of which hospital you go to, your insurance makes you pay three sticks of whole wheat pasta.

Why then is it valuable to know how many oranges my hospital vs. the other two charges?

It has no impact on your pasta. It has no impact on your pasta. It has no impact on your pasta.

If you just want to know so you can know...that's fine. Curiosity is reasonable. Spending money to figure out things for your curiosity is not necessarily reasonable however.

The only proposed use for the orange you've given me is for "informed consent," but informed consent would be the pasta, not the orange. The orange has no impact on the patient.

If it has one please provide it.

Your charge and the negotiated rate are both denominated in US dollars in the US. (So are all of the other terms in their health insurance policy.) US legal tender laws are a hell of a drug, so unless you're extremely transparent up front about your pricing structure being in terms of oranges (in which case, you are probably transparent enough as it is... and you certainly don't work with any US-based insurance companies), yours is denominated in US dollars, too.

I mean, this is how silly you've gotten. Wow. I hope you're really good at medicine, because I'm starting to get the impression that you just don't understand how any other aspect of the world works.

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