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Notes -
Fundamentally I'm not against greater cost transparency if you don't break something else in the process, but some of the difficulty serves a purpose (mostly in the hospital vs insurance war).
The other piece to keep in mind is that this is pretty much how a bunch of the expense of our system came to be. Someone had a great idea for how to improve the system. The idea had uncertain benefits and costs. It got thrown out there and ended up costing more than it benefited. I'm not convinced the costs associated with cost transparency (one poster elsewhere suggested that hospitals eat the loss of cost overruns in a surgery for instance) end up being better once you add everything up. You should be damn sure.
I quoted the above part because fundamentally the rest of the system prevents us from being too cost conscious. "Here are the benefits and risks of your gyn surgery written on a paper. A routine complication is the ureter being severed. It happens. Nobody necessarily makes a mistake but it happens. Actuarially it will happen. Please don't sue us. In fact this paper says you can't sue us." Result: lawsuit. "You could die if you leave the hospital. No really your arm is literally falling off and you will die from infection within 48 hours I can fucking see the pus oozing out of you Jesus Christ. Fine sign this form saying you are leaving against medical advice and won't sue us." Result: lawsuit. (both of these examples are making fun of specific things I've seen and aren't really real).
More centrally you see things like "meemaw is a fighter, use enough resources to build a jet fighter to try and save her life even though she is 97 or we are going to sue the shit out of you."
You have to revise a lot of other things before that becomes viable.
We try and do things where we can like offering a slightly less effective but much cheaper medication.
Sure, I think that most doctors probably do what they can within the system as it is. But a lot of patients are unhappy with the system as it is. And by the sound of it many doctors are unhappy with the way it is as well.
And while extrapolating from a single act is not a good idea, the number of people who were somewhat or actually supportive of the out and out murder of an Insurance CEO may indicate that something needs to change.
So I suppose the question is, from someone within the system if you were told: "The people are about to rebel and start executing insurance CEOs, hospital CEOs, doctors and more, and we must change to make the system more transparent and cheaper and to not make Drs work insane hours, we don't have a choice" what would you recommend? You have been endowed with decision making power and insurance CEOs are so scared they will follow your decisions. What would you do?
Previously I've advocated for tort reform as a way to reduce defensive medicine and cost of care, but elsewhere in one of these threads it was pointed out to me the complexity of addressing that (fixing things is hard, who knew haha).
There should be a way to reduce administrative burden - capping profits more diligently and reducing overhead /forcing institutions to be lean should be feasible. Health insurance companies and healthcare admin are both hideously bloated and didn't use to be that way, and I'm sure well intentioned regulation is what caused the problem.
In my mind it is fundamentally the same question as "lets make college cheaper again" similarly hard to fix but what works for one will probably work for the other.
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